Sixth Form and Further Education Funding

Baroness Sharp of Guildford: asked Her Majesty's Government:
	What plans they have to ensure that funding for school sixth forms matches that for further education colleges.

Baroness Ashton of Upholland: My Lords, the Government have set out their investment plans for 2003–04 to 2005–06, which should enable the Learning and Skills Council to increase funding for further education significantly. For the academic year 2003–04, core funding rates per qualification increased by 3 per cent for school sixth forms and by 4.5 per cent for further education colleges, on a broadly comparable basis. Our expenditure plans to 2006 should see that trend continue.

Baroness Sharp of Guildford: My Lords, is the Minister aware that for reasons of differences in accounting conventions, the seeming difference between the money going to school sixth forms and to colleges is not what it appears? The LSC itself confirms that the 10 per cent funding gap between the two remains and will continue. Given the expansion in numbers in further education colleges and sixth-form colleges expected as a result of the rolling out of educational maintenance allowances next year, can she assure us that colleges will have the resources that they need to fund the increased demand that will be made on them during that period?

Baroness Ashton of Upholland: My Lords, the noble Baroness is absolutely correct: the funding gap is approximately 10 per cent. We see that being closed; progress is being made; we anticipate that that will continue and the resources are available in the LSC budget.

The Earl of Listowel: My Lords, next year, the Government will be spending £5 billion on school buildings, but only £400 million on college buildings. Can the Minister give an assurance that there will be adequate facilities and equipment to meet the needs of the extra students arriving in colleges? Will she confirm that such colleges are especially beneficial environments for many children in care and leaving care, because of their greater vocational bias?

Baroness Ashton of Upholland: My Lords, I can confirm that £400 million is indeed being provided—an increase from £231 million in 2002. Part of the building schools for the future programme is to enable us to work closely on the strategy for 14 to 19 year-olds between colleges and schools to enable us to develop appropriate resources. That includes developing the skills of looked-after young people.

Lord Forsyth of Drumlean: My Lords, given the recent report that showed that about 3,500 children or youngsters from schools were not getting places at our top universities because they were not applying for them, should not the Government be focusing their attention more on what is happening in sixth-form colleges and schools, rather than attacking the universities?

Baroness Ashton of Upholland: My Lords, that is an interesting question, although, if I may say so politely, slightly tangential to the original Question. I can tell the noble Lord that, as we debated during discussion of the Higher Education Bill, it is not an "either/or" but a "both/and". It is critical that we support our children and young people in whatever educational setting, allowing them to use their qualifications, skills and abilities to get as far as they possibly can and to have the best life that they possibly can.

Baroness Maddock: My Lords, can the Minister reassure me that the funding gap—especially in salaries—between teachers in sixth-form colleges as opposed to further education colleges will be addressed sooner rather than later? I welcome the extra money that she said that the Learning and Skills Council will receive, but she will know that it is an increasing problem for FE colleges to keep the staff that they need for their A-level courses. I declare an interest as a governor at such a college.

Baroness Ashton of Upholland: My Lords, the noble Baroness makes an important point. The figures for additional resources that I gave of 3 per cent and 4.5 per cent take account of money being made available to ensure pay and pension funding.

Lord Roberts of Conwy: My Lords, what is the comparable per capita funding for sixth-form college students and further education students? I am bound to say that my impression is that sixth-form colleges do rather better on per capita terms.

Baroness Ashton of Upholland: My Lords, I forgot to say happy birthday to the noble Baroness, Lady Maddock; I gather that it is her birthday today.
	The figures that I have for the published base rate funding for AS/A2-level provision for 2002–03 are £663 per student in the FE college sector and £734 per student in schools, which, as I said, is approximately a 10 per cent gap. So the noble Lord is absolutely right about the gap.

Baroness Sharp of Guildford: My Lords, is the Minister aware that last year, the college sector increased enrolment by 7 per cent, compared to 2 per cent in the school sector, and that some 50 colleges that increased their numbers partly in pursuit of government incentives—there was a desire to do so—are still waiting for the extra payments for the students they took on?

Baroness Ashton of Upholland: My Lords, I was not aware of that; but I will of course ensure that my honourable friend the Minister responsible is made aware of that.

BAe Systems

Lord Astor of Hever: asked Her Majesty's Government:
	What their reasons are for not giving BAe Systems plc preferred contractor status for defence procurement projects.

Lord Bach: My Lords, as was made clear in the Government's defence industrial policy published in October 2002, competition remains the bedrock of our procurement system as it is often the best means of securing best value. However, competition is a means to an end and not a dogma. Individual procurement strategies are always considered on a case-by-case basis. BAe Systems is well placed to continue to win work from the Ministry of Defence.

Lord Astor of Hever: My Lords, I am grateful to the Minister for that reply. The quarrel conducted in the media between the MoD and BAe, our biggest defence contractor, is bad for the MoD, for BAe and, most importantly, for our Armed Forces. What are Ministers doing to restore that important working relationship? Will the Minister confirm that in accordance with the recommendations of the National Audit Office, the MoD will not be managing the contract for the new carriers?

Lord Bach: My Lords, the defence industrial policy is aimed at supporting the whole of the UK defence industry and not individual companies, however distinguished they are. Obviously, we very much value the work of BAe Systems and the equipment and economic benefits that it provides. Our relations with the workforce of that company continue to be excellent. I pay tribute to their dedication and commitment.
	We agree with the company on many issues, but we have different responsibilities. We are government; it is a private company. We cannot always expect to agree on everything. Indeed, if there was no tension in a relationship between a government and any defence company from time to time, that would be a fault rather than a virtue. Of course, companies will always pursue their individual objectives as their shareholders see fit. Our priority remains to deliver capability to the Armed Forces when they need it and at value-for-money for the taxpayer.

Lord Redesdale: My Lords, in the Government's view, what effect would the speculated bid by BT Systems for the shipbuilding and submarine-building arm of BAe shipyards have on the carrier contract?
	I know that this is slightly wide of the Question, but will the Government enter into the fray of whether the joint strike fighters are too heavy to land on the carriers which are being built for them?

Lord Bach: My Lords, the noble Lord is certainly right in one thing: that is certainly wide of the Question that I was asked. I think he knows that I cannot answer those questions today, even if they were absolutely on the ball, which, for once, they are not.
	As far as CVF is concerned, the noble Lord knows that my right honourable friend the Secretary of State announced on 30 January that we believe that the best means of delivery in the carrier programme is by an alliance approach involving BAe Systems, Thales UK and the Ministry of Defence. As regards shipyards, at this stage that is a matter for the private companies involved.

Lord Campbell of Alloway: My Lords, is the noble Lord aware that the reasoning that he has given for the action that has been taken does not appear—certainly to me—to be wholly satisfactory? The preferred contractor is a safeguard for our Armed Forces and the security of the type of equipment that is put forward.

Lord Bach: My Lords, the whole CVF concept—that is, the new aircraft carriers—is an extremely complex and demanding programme in respect of time and cost. The alliance approach, in which we hope that BAe Systems will play a major part along with other companies, will allow us to draw on the strengths, resources and expertise of all parties involved and provide the most effective way of managing both risk and reward. I am sorry that the noble Lord is not yet persuaded, but I shall work on him.

Lord Craig of Radley: My Lords, does the concern of the Government, in not accepting BAe Systems as a preferred contractor, have anything to do with the possibility that that company might amalgamate with an American one?

Lord Bach: My Lords, I have to tell the noble and gallant Lord that negotiations on all of those issues, including the preferred contractor issue, are continuing with the companies involved in order to determine the most effective contracting strategy for the aircraft carriers. It is not our intention to force out any company or supplier. It has nothing to do with what on the whole are fairly unfounded stories in the press this weekend about the short take-off vertical launch (Stovl) version of JSF.

The Countess of Mar: My Lords, does the noble Lord agree that Her Majesty's governments—in plural—over a number of years have had a sorry record in safeguarding taxpayers' money as regards MoD contracts with various suppliers? What are the Government doing to ensure that contractors meet times and costs as originally contracted?

Lord Bach: My Lords, when going back over years in general terms, I do not think that there is a bad record as far as the taxpayer is concerned and certainly not as far as concerns the Armed Forces. They enjoy—they are the first to say so—some of the best equipment in the world, which is the envy of many other countries. So I do not agree with the proposition.
	Of course, we can improve our procurement policy. I do not know how long the House has got: not very long, I suspect. We have brought in the principles of Smart Acquisition, which means in short that we work closer with industry. We ensure that we spend enough money and enough time at the assessment phase of each project, so that when we meet the manufacturing phase we do not find those delays and, thus, those cost increases that lead taxpayers and newspapers sometimes to complain.

Lord Haskel: My Lords, my noble friend will be aware that in the recent innovation White Paper there was an item that said that the Government would try to be a purchaser who encourages innovation. Can my noble friend confirm that the MoD is encouraging innovation by its purchasing policy?

Lord Bach: My Lords, that is certainly what we intend to do. As I said, this is an extremely complex field. A great deal of taxpayers' money is involved here. It is very important that what we do is responsible, but there are new flexible ways of procuring equipment. We have got to find the right way in each case.

Lord Tebbit: My Lords, as the Minister seems to be prepared to go slightly wide of the original Question, will he tell the House whether Her Majesty's Government have paid damages to ETC, the American company that failed utterly to fulfil its contract for building the Royal Air Force centrifuge, which has now fallen into complete abeyance?

Lord Bach: My Lords, I knew I had made a mistake in answering the noble Lord, Lord Redesdale. I might have known that it would be the noble Lord who would take me up on it. I am about to reply to the noble Lord's Written Question. It is not the first Written Question on this legitimate subject. I am afraid that I do not have the answer in my head.

Dental Services

Baroness Gardner of Parkes: asked Her Majesty's Government:
	Whether the degree of access for patients to National Health Service dental services is satisfactory.

Lord Warner: My Lords, the Answer is no. That is why the Government are undertaking the most radical overhaul of NHS dentistry since 1948 through legislation in the Health and Social Care Act 2003, which transfers responsibility for commissioning NHS dental services to primary care trusts. In addition, we have targeted £59 million to improve access to NHS dentistry across England: £50 million to primary care trusts for specific local initiatives, and an additional £9 million specifically targeted to the 16 most challenged areas for dental access, supported by the NHS dentistry support teams.

Baroness Gardner of Parkes: My Lords, I thank the Minister for that reply. Is he aware that the British Dental Association has carried out extensive consultations on the Government's proposals for the future and has come up with very unfortunate results? The profession as a whole believes that there is a failure to address chronic underfunding in the NHS and it has many other objections. However, all the results add up to serious misgivings and an overwhelmingly negative view of the Government's proposals. The consultation reveals that 57 per cent of dentists oppose the proposals and that only 15 per cent support them. Nine out of 10 dentists think that they will increase their private work and 60 per cent of them personally intend to reduce their provision of NHS services or to opt out of the NHS altogether. Is that not a very discouraging result of the consultation? What further consultations and changes do the Government propose to address these issues to reassure members of the dental profession?

Lord Warner: My Lords, it is worth reflecting on the fact that pretty extensive consultation took place with the professionals' negotiators before the legislation was put before the House in the Health and Social Care Bill. There has been extensive consultation on the new base contract and the other transitional arrangements, all of which add up to strong protection for three years so that dentists lose no income. The Government are considering the results of that consultation. My honourable friend Rosie Winterton will be responding to it in the not-too-distant future.

Lord Clement-Jones: My Lords, with only three-fifths of adults and two-fifths of children in this country registered with an NHS dentist, there is clearly a crisis of confidence among the dental profession. That is why it is so difficult for adults and children to register with an NHS dentist. What the Minister has said does not really address that crisis of confidence, when the BDA survey shows a huge lack of confidence in the future in terms of contractual obligations. Dentists fear that a treadmill is being created and they have doubts about the PCTs' capacity to cope in those circumstances. What are the Government going to about it?

Lord Warner: My Lords, the noble Lord mentioned treadmills but the treadmill problems of dentistry go back to the debacle of the 1990s contract and the shambles after that, which led to a fee cut and the flight of dentists from the NHS. That was not under this Government. We have been putting more money into dentistry. The fees paid to dentists are up. The numbers of NHS dentists are up by 4,000 since 1997. We have invested £90 million in dentistry during the past year. Oral health in children is improving and the number of people who need an intervention after initial assessment is also up since 1997. We accept that there are problems, but it is not all doom and gloom.

Baroness Masham of Ilton: My Lords, why is Scarborough in North Yorkshire having such a problem in recruiting dentists when it is such a pleasant place to live?

Lord Warner: My Lords, I must pass on the bad news to the noble Baroness that among the 16 hotspots are places such as the Isle of Wight and the New Forest. Pleasant places to live do not always attract NHS dentists.

Baroness Hooper: My Lords, will the Minister reassure me? I understand that in spite of the Government's funding proposals, which sound quite generous, some primary care trusts may be deliberately delaying the processing of applications for numbers—that is, numbers with a capital "N"—to be added to the list of dentists because they are worried about the costs. Is that a general reaction or an isolated occurrence?

Lord Warner: My Lords, the new contract has not been agreed with the profession or introduced, so I am not sure that PCTs could be worried about the cost of the new contract. Certainly, more money has been put into PCTs during the past year and the allocations have now been agreed for the current year. It is down to PCTs to design as best they can the dental services fit for their particular area.

Lord Skelmersdale: My Lords, it is all very well blaming the last Conservative government, but I rather thought that this Government had been in power for seven years. Why has it taken them so long to grasp this particular nettle, which, as we have heard, has resulted in a dentistry desert in this country?

Lord Warner: My Lords, if a previous government shut two dental schools, it is quite difficult to increase the supply of dentists very quickly. That is what we were faced with. Despite that, we have increased the number of places in existing dental schools. We have increased the number of dental hygienists and dental therapists. As I have said, the number of NHS dentists has increased by 4,000 since 1997.

Baroness Oppenheim-Barnes: My Lords, is the Minister aware that on this very morning a lady telephoned the Jeremy Vine radio programme to say that she had had to extract her own teeth after drinking three pints of lager because there were no NHS dentists anywhere near her and no list would accept her?

Lord Warner: My Lords, I am afraid that I did not hear the Jeremy Vine programme this morning. I was opening another of the Government's success stories—the UK stem cell bank.

Lord Colwyn: My Lords, is the Minister aware—I am sure that he is—that the NHS dental workforce review was announced in 2001 by his noble friend Lord Hunt and is still not published? The dental profession is waiting patiently. Those in the NHS need to be convinced that it is a service in which they want to continue to work. Will he give us a date for publication as a matter of urgency?

Lord Warner: My Lords, I have said on previous occasions that we are working assiduously on the dental workforce review. I am assured that it will be published shortly.

Baroness Gardner of Parkes: My Lords, will the Minister assure me that not too many cases will be the same as that sent to me by a dentist about his son, who qualified here at Guy's, did his all vocational training and went to work in Australia, where he continued to work in dental practice? When he applied here to have the right to practise as a dentist, he was told that he will have to wait for at least six weeks. If we really need people in the NHS as urgently as we do, why would there be such a delay for a very well qualified—British qualified—dentist?

Lord Warner: My Lords, I know that the noble Baroness knows that we are always keen to have such talented dentists as herself coming from Australia. I shall certainly look into the particular case that she raises and let her know the answer.

Arms Exports

The Lord Bishop of Salisbury: asked Her Majesty's Government:
	Whether they plan to introduce further legislation in this Parliament to control the export of arms.

Lord Sainsbury of Turville: My Lords, no further legislation is currently planned. The three orders that implemented the Export Control Act 2002 came into force only this year, on 3 March and 1 May. The Export Control Act 2002 was the most comprehensive review of strategic export controls for more than 60 years. It introduced significant controls into new areas such as the intangible transfer of technology and the trafficking and brokering of overseas military equipment. The Government are committed to review their operation after three years and will bring forward any necessary changes at that point.

The Lord Bishop of Salisbury: My Lords, while I thank the Minister for his reply, can he confirm that the pledge given at the last general election to control the activities of British arms dealers "wherever they are located" remains unmet because a broker will still be able to transact a deal that is illegal in the United Kingdom simply by crossing the Channel? Furthermore, in view of the fact that this country is the second biggest arms exporter, are Her Majesty's Government ready to take a lead in brokering the efforts to agree a more comprehensive global arms trade treaty?

Lord Sainsbury of Turville: My Lords, we believe that we have fulfilled the 2001 manifesto commitment. There is the question of how far we extend the control of trafficking and brokering. We took the decision that this would apply where there is general international condemnation of particular action, because we think that extra-territorial jurisdiction in other circumstances is extremely difficult to administer. Obviously, trafficking and brokering controls are most effective when they are imposed on a multilateral basis. That is why the UK was the driving force behind the common position on arms brokering under the EU's common and foreign security policy, agreed in June 2003. That obliges all member states to introduce national controls on arms brokering. On that basis, it is very much more difficult for UK brokers to evade the controls by crossing a UK border.

Lord Avebury: My Lords, the right reverend Prelate's Question refers to arms exports in general and not simply to those from the United Kingdom or by UK citizens. What steps have Her Majesty's Government taken to give teeth to the OSCE's code of conduct on arms exports, which was agreed as long ago as 1993 in Budapest, particularly to persuade countries in eastern Europe such as Ukraine and Belarus, which are serious violators of the code, to observe its terms? Could not the international community agree that where illicit weapons are recovered from theatres of conflict, they are examined for serial numbers to see if they can be identified back to the countries of origin?

Lord Sainsbury of Turville: My Lords, the UK Government support the goal of an international instrument. That is why we believe that the proposals for an international arms trade treaty are to be welcomed as a contribution to this debate. Of course, we have to make certain that enough of the major arms exporting countries support such proposals, because if it is to make sense it has to have that support. In principle, we very much support that initiative.

Lord Campbell-Savours: My Lords, is the defence establishment still blocking proposals for the DESC—the Defence Exports Scrutiny Committee?

Lord Sainsbury of Turville: My Lords, we have covered this matter at considerable length in previous debates. I have no reason to suppose that the situation has changed, although I am not certain that I would agree about who is blocking what.

Lord Hylton: My Lords, can the Minister tell us how the Government are exercising end-user control over approved military exports? In particular, will they insist that old weapons are destroyed when new ones are supplied?

Lord Sainsbury of Turville: My Lords, there is clearly an important question in terms of where arms are diverted to different destinations through particular countries for which a licence is given. Where there is any clear risk that a proposed export will be diverted to another end-user, then the licence will be stopped. A licence is now required under the new trade controls to transfer ownership of military goods between overseas countries, so there is a further block there.

Baroness Miller of Hendon: My Lords, does the Minister agree that the arms industry contributes substantially to United Kingdom exports and jobs, and that it is subject to a far more stringent regime than that of competing countries, which are less assiduous in enforcing compliance with end-user certificate systems?

Lord Sainsbury of Turville: My Lords, the arms industry obviously provides a considerable number of jobs. It is subject to a stringent regime which I think is totally appropriate, given the nature of the industry.

Lord Judd: My Lords, does my noble friend agree that while the Government should take credit for having pioneered the European code on arms exports, it is now essential to have the strictest possible approach to the application of our own criteria when decisions are being made about exports? Does he also agree that following 9/11 and the reality of international instability that confronts us, we must change the culture from one in which it is okay to export arms unless there is a very good reason for not doing so to one where it is very dangerous to export arms unless there is a very good reason for doing so?

Lord Sainsbury of Turville: My Lords, it is of course government policy that there should be a strict application of the criteria for licences for the export of weapons. The important thing is to apply those criteria very stringently. That is government policy, and I think we should act in line with that policy rather than introducing any other criteria.

Somalia

Lord Avebury: asked Her Majesty's Government:
	What information they have about the progress of negotiations on a lasting peace settlement in Somalia.

Baroness Crawley: My Lords, having reached agreement on a transitional federal charter in February, the Somalia National Reconciliation Conference lost some of its momentum. However, we understand that Foreign Ministers from the region plan to meet Somali leaders in Nairobi tomorrow to discuss a way forward.

Lord Avebury: My Lords, is there any reason to suppose that if tomorrow in Nairobi the faction leaders agree to a parliament, as they are meant to, they will honour the agreement any better than they have done the ceasefire or the transitional charter? Does the noble Baroness agree that the peace process is fundamentally flawed because of its changing cast of warlords, the repeated violations of the ceasefire, the violations of the UN arms embargo and the general attitude of the players to the process itself? Would it not be an idea for Her Majesty's Government to suggest repatriating the peace process to Mogadishu, where large bills would not be run up at expensive hotels and the minds of the participants might be concentrated on the security problem?

Baroness Crawley: My Lords, I respectfully disagree with the noble Lord, Lord Avebury. The Government do not believe that these talks are futile. This process, as the noble Lord has said, has been very long and difficult, and of course there is no guarantee that it will ultimately be successful. However, fear of failure is no reason not to try. We owe it to the Somali people to support all credible efforts to bring peace, stability and democracy to their troubled country. In those terms, I believe that we have a hopeful initiative from the regions' leaders to try to restart these negotiations tomorrow.

Baroness Rawlings: My Lords, what support have Her Majesty's Government provided to help the estimated 35,000 internally displaced people resulting from the latest clashes? What support have Her Majesty's Government given to the UNICEF programme to help to eradicate female mutilation in Somalia?

Baroness Crawley: My Lords, DfID has given up to £6 million of support for humanitarian assistance throughout Somalia, and that is just from last year's budget. That assistance will cover humanitarian aid and health issues particularly where children are concerned. The noble Baroness will know, from her own experience, of the enormously serious problem of malnutrition in children in Somalia.

Lord Addington: My Lords, has the monitoring group on the arms embargo reported recently? I am informed that it has not done so for over six months. The flood of arms into Somalia is a serious cause of its destabilisation.

Baroness Crawley: My Lords, I have good news for the noble Lord: the group monitoring the UN arms embargo on Somalia is meeting this afternoon and publishing its latest six-month report.

Lord Avebury: My Lords, has the noble Baroness seen the report of the international crisis group? It suggests that the process should be widened to allow traditional elders, representatives of civil society, religious organisations and private sector figures to participate and that Somali ownership of the talks should be encouraged. Does she not think that the reduction of the number of participants from 355 to 203, as is being done for the meeting tomorrow, is likely to limit Somali participation and reduce the chances that the outcome of that meeting will be accepted by the Somali people as a whole?

Baroness Crawley: My Lords, as the stakeholders have worked so hard to get to the point of restarting the talks, we will make as much effort as we can to support them and to facilitate the talks starting and not failing. However, I note what the noble Lord has said and if these talks fail again—the noble Lord will know that a time limit has now been set for these talks and that they cannot go beyond the end of May—then one of the areas that the international community will consider is the building blocks approach that he suggested. That is an approach in which we work with the diaspora, civil society, business representatives and women's groups in stable parts of the country to help them to develop consultative and democratic structures at grassroots level.

The Countess of Mar: My Lords, are we not trying to impose our type of democracy on to what is still essentially a clan society? Should we not be trying to get the heads of the clans to work together, especially the minority clans that have been very downtrodden? We have a lot of asylum seekers from those clans in this country.

Baroness Crawley: My Lords, I agree with the noble Countess. Our approach is not to impose our model of democracy. As she rightly says, Somalia is a country built on clans and decisions are made through the leadership of those clans. Therefore, we are looking for an assembly or legislature that will be the end-product of the talks and that will be built through the clan system. We are doing everything that we can to support that.

Baroness Park of Monmouth: My Lords, has the African Union played any part in this and, if not, is it expected to do so?

Baroness Crawley: My Lords, I will get back to the noble Baroness on whether the African Union has played a part. Of course, the region's frontline countries have played a part, that is the west African and Horn of Africa countries. The talks are in Nairobi, Kenya, and all the neighbouring regional countries have been very involved. On the specific question of the African Union, I will come back to the noble Baroness.

Personal Statement: The Baroness Golding

Baroness Golding: My Lords, with permission, I should like to make a personal Statement.
	I regret to inform the House that the people involved in the incident earlier today at Prime Minister's Questions were there at my invitation. I am, of course, deeply distressed by this. As your Lordships would expect, I am giving all the information I have to the authorities. I have also seen the Speaker of the House of Commons and apologised to him unreservedly and, through him, to all Members of the House of Commons. My Lords, I should also like to apologise to everyone in this House.

Business of the House: Debates this Day

Baroness Amos: My Lords, I beg to move the Motion standing in my name on the Order Paper.
	Moved, That the debates on the Motions in the names of the Lord Monro of Langholm and the Lord Fowler set down for today shall each be limited to two and a half hours.—(Baroness Amos.)

On Question, Motion agreed to.

Olympic Games 2012: London Bid

Lord Monro of Langholm: rose to call attention to the Government's policy on sport and the progress of the London 2012 Olympic Bid; and to move for Papers.
	My Lords, at the outset of this debate I declare an interest as a member of many sports clubs and as past president of three governing bodies. The timing of this debate is most appropriate. We are all extremely pleased that London is on the shortlist for 2012. Of course, that was expected but we must be concerned at the criticism by the IOC on two main counts: transport and public support. I find the latter poll surprising. With the leadership of the bid team and with all-party support, I have confidence that we can improve that figure substantially. But we have a problem with transport. We all knew that it was likely to be a stumbling block but the IOC's criticism is more severe than expected.
	I note that the Prime Minister has given full support to the bid and has offered help with transport. It is an urgent matter because plans for the final bid have to be in place by November 2004, which is not that many months away. So there must be a great deal of action between transport, Treasury and planning if we are going to get the bid on the top line. I think that we should aim for 2011 rather than 2012 to give time for everything to bed in and for the snags to be removed. In this Chamber we are blessed with three Olympic medallists—the noble Lords, Lord Coe, Lord Moynihan and Lord Glentoran—who will make contributions from time to time.
	It is important that we begin by looking quickly at Athens in 2004. I am pleased that Simon Clegg of the British Olympic Association, the IOC and press reports confirm that all facilities will be ready. That is good news. We wish our team well and hope it will do even better than it did in Sydney. Of course, we are all worried about security and today's events show what can happen. However, I am relieved that the Greek Government are taking every possible precaution. I was the government Minister at Munich on the day of the assassination of the Israeli team in 1972 and I know how it affected the spectators and the participants. Two days later, it was wonderful to be cheered up by Mary Peters winning the gold medal.
	So I turn to the 2012 Olympics. Before the Secretary of State made her Statement a year ago, we were critical of the lack of progress and lack of decision. Major disappointments over the World Athletics Championship of 2005, Wembley, Picketts Lock, Sheffield and even the Dome put us on the back foot. But today we want to put all that behind us and look forward to 2012. However, I would ask the Minister to tell me in his reply what has happened to the £21 million that were given to Wembley for the athletics track, which now does not seem to be going to happen.
	Twelve months ago, we gave a warm welcome to the Secretary of State. We called for a supremo to head the bid team and we were delighted at the appointment of Barbara Cassani and Keith Mills. I think that the bid team has worked wonders in a year. It has used imagination, it has vision and knows exactly where it is going. It must keep it up until the final vote next year and keep it an all-party, one nation bid.
	We had a word of warning at the weekend. Those who watched the announcement about the football World Cup saw that votes were swung at the very last moment by a major personality. That could happen to us in July of next year. It may be that the noble Lord, Lord McIntosh, will have to metamorphise into Nelson Mandela at that time.
	I strongly support the Paralympics that follow on from the main Olympics. I went to see them in Rochester when they were called the "Special Olympics". I know how much it means to the participants and to the friends and relatives who travel with them. In winding up, perhaps the Government will give us a rough estimate of the costs for 2012. In particular, can the Minister say how much extra London council tax payers will have to pay?
	It is always said that sport and politics should not mix, and in some ways they do not. The late Lord Howell—Denis Howell, whom your Lordships all remember so well—and I were Minister of Sport and shadow Minister of Sport for about 11 years between us. We got on extremely well; we discussed appointments and policies together. I do not believe that we ever had a disagreement, which is as it should be.
	However, government involvement in every sport is now great. They fund the four councils—give or take the Scottish and Welsh position—and UK Sport and support the CCPR. That body is immensely important in welding together all the governing bodies of sport in this country. It does a tremendous job. I know that in the future we must deal with its major problem with minimum wages and volunteer coaches, which seems to have reached an impasse with the Treasury.
	The Government should keep their distance with regard to major political decisions, which are a matter for the governing body. Therefore I say that they have been right in their handling of the problems of Zimbabwe and the cricket tour. It is inconceivable that England should play in that country in the foreseeable future. The team must not go, whatever the consequences. However, at long last it seems that over the past few days the ICC has accepted that there is a crisis in cricket that must be resolved as quickly as possible. I believe that principles are far more important than money, in which I am supported by the majority of the country.
	I am impressed by Sport England's framework for sport, which was published recently. I congratulate Patrick Carter and Roger Draper on its production. Over the years, sport has been bedevilled with bureaucracy, delay, conferences, reports and so on. We want to see more action with the money available being spent quickly. We must support the countless volunteers who run the sport in this country and do so for nothing. They cannot spend their lives filling in forms in order to obtain grants from the Sports Council. The framework should fast track that process and set up a streamlined system. My suggestion to Sport England is that it should aim for an earlier year than 2020 for its completion—more like 2012 or 2015.
	Sir Andrew Foster has just produced an exceptional report on athletics, which should help us regain the momentum of Sydney and replicate the achievements of the four-minute mile. It needs early action from the various associations within athletics. They should come together in a spirit of harmony, perhaps with David Moorcroft in charge. There is no time to waste when facing an Olympics and world championships thereafter.
	Will the Minister say how much of the £41 million legacy given to athletics after the Picketts Lock disaster is now being actively spent on athletics? Tennis is a similar issue. Wimbledon is a huge and successful national sporting event. Much of the profit from the All England Club goes to the Lawn Tennis Association and helps with the new centre at Roehampton.
	Let us hope that it will bring in an early result. We have only Tim Henman in the first 100 men or women. It is time, when there are thousands of club players in the country, that some come forward to set the standard we require internationally.
	Will the Minister say a word or two about swimming pools? They seem a frightful headache for many local authorities. I know that the costs of running pools are high, but every child should have the chance to learn to swim and far too many do not.
	I turn to playing fields, on which I have sparred with the Minister previously. In its 1997 manifesto, the Labour Party gave a commitment to stop the sale of playing fields, which it reaffirmed in 1998. It is difficult to obtain statistics on playing fields because the base is flexible and sometimes excludes playing fields made into sports halls. But in 1999 to 2003, applications increased from 590 to 1,297. Of those 1,297 applications in 2003, 807 were approved to remove the playing field and turn it into some other development. That is a long way from the manifesto promise.
	In the same period, the Government approved 174 out of 176 applications for areas of 0.2 hectares—roughly the same size as a football field. It does not seem that we are doing much about retaining playing fields in schools. Indeed, the Government approved 36 applications against the specific advice of Sport England. Alison Moore-Gwyn and Elsa Davies of the National Playing Field Association are most active in keeping the playing fields of this country at the forefront of policy. They think we should have a proper independent audit of what is going on in the playing field world so that we can get some facts and not a whole lot of smudging as from Written and oral Questions that I have asked in the past.
	While we are on the subject of playing fields, I hope that the Government are giving all the help they can to school sports. I know that they announced a programme of £578 million two years ago, but according to the last figure that I was able to obtain only £4.6 million has been spent. Why is it taking so long to get money spent on schools where we want it to be spent?
	Team games are so important in schools. They bring out leadership and develop character. They teach people to understand what umpires and referees are about. They are also so good at developing activities in outward bound fields. It is amazing how children can achieve something that they never thought was possible when they are taken to an outward bound event such as climbing hills or mountains. The development of character in education is desperately important.
	I want to close with a quick word on drugs, which is such an important issue and so difficult to quantify. I was concerned that Michelle Verroken, who was for 18 years head of the anti-doping unit, was recently dispensed with. She was interviewed by the Select Committee in another place, where she said that her integrity was not for negotiation. Was she being asked to make some changes to the arrangements for drug testing? I want to know, because so many governing bodies find every conceivable excuse for trying to support their competitors against the drug efforts of that team.
	Not all is doom and gloom, I am glad to say; far from it. We must be proud of what we have achieved in recent years and the leadership that we give to sport. Clive Woodward has done so much for rugby. Sweetenham has done so much for swimming. Rowing, sailing and equestrianship are going well. I am sure that all those sports and others such as cycling will be bringing back medals from Sydney.
	In golf we have three of the four great trophies: the Walker Cup, the Ryder Cup, the Solheim Cup and with luck next month we might also have the Curtis Cup. Many things are going well and I am not in any way criticising—I am here to say "well done" to the governing bodies that run those sports. We must aim high at the stars, support our volunteers and coaches; but, above all, we must get on with things quickly and spend the money available wisely and as soon as possible. Action will bring results, and who knows what Great Britain can achieve? I beg to move for Papers.

Lord Paul: My Lords, first, I congratulate the noble Lord, Lord Monro, on initiating such an important and timely debate. Just yesterday we heard from the International Olympic Committee that London is on the shortlist as a candidate city to host the 2012 Olympic and Paralympic Games. We now have an opportunity to go forward in this exciting competition.
	I am sure that noble Lords will join me in congratulating all those involved in building a bid and getting us to this point in such a tough field of competition.
	At this point I would like to declare an interest as a board member of the London Development Agency, a key funder and partner in delivering the Games. I am also a member of the board of the bidding organisation, London 2012, and a member of its Ethics Advisory Group.
	We have heard today about the tremendous potential the Olympics have for not only delivering excellence in sport but creating the inspiration among young and old alike to participate in sport at every level.
	Staging the Olympic and Paralympic Games in London would be a tremendous honour. It would provide a platform for us to get people active, thereby improving health, social cohesion, and even performance in schools and productivity at work.
	The Olympics are, of course, the biggest sporting event in the world. However, perhaps one of the greatest strengths of London's 2012 Olympic bid is that it is about so much more than sport. It is also the greatest cultural festival. It gives us a unique chance to celebrate Britain's rich cultural diversity and promote London as the creative capital of the world. I know, for example, that the Asian community is very proud and most enthusiastic about this opportunity, as are all Britain's other communities.
	The London Development Agency, together with London's government and central government, is committed to a large-scale regeneration project in the lower Lea Valley—part of east London that has some of the most deprived wards in the United Kingdom. This area has been neglected for too long. Levels of ill health in the lower Lea Valley are very high. Residents in Newham can expect to live five years less than their not so far away neighbours in Kensington and Chelsea. This is unacceptable.
	The Olympics would give us a chance vastly to improve the physical environment by doubling the amount of green space in the area. They would help to create thousands of new jobs, new homes and business opportunities. It is not just east London that would benefit. The whole of London and the rest of the UK will reap huge rewards if we are fortunate enough to host the 2012 Games. I hope that noble Lords will allow me to congratulate my right honourable friend the Prime Minister, the Secretary of State for Culture and the Mayor for London on their great support, enthusiasm and encouragement and on having made it possible to get so far.
	Business sectors such as tourism and hospitality, food and creative industries and, of course, the construction sector, would receive a major boost along with thousands of other potential business benefits. What is also so crucial to London's bid is its legacy. London's bid provides a sustainable legacy for communities after the Games, not just in the world-class sports facilities they would leave behind, but also the jobs, homes, improved environment and lasting public health benefits.
	I would also like to make a special mention of the Paralympic Games. This country's commitment to disability sport over many years has helped to establish the Paralympic Games in the global consciousness. It will be an honour to welcome the whole Olympic family when they come to visit. The country has taken on a great challenge in bidding for the Olympic and Paralympic Games—one that many thought we were not up to.
	After yesterday's announcement it is clear that huge efforts have been made to get us this far, and that there is the commitment to see the job through to the end, hopefully with a successful conclusion in Singapore in July 2005.
	For those who question our ability to succeed this is a unique opportunity for us to prove that we can deliver the best Games ever. I call on noble Lords to play their full leadership role in getting behind this bid.
	I apologise for the fact that I shall leave the Chamber for about half an hour to attend the Finance Bill sub-committee meeting to hear evidence. However, I shall return shortly.

Lord Brooke of Sutton Mandeville: My Lords, it is a pleasure to follow the optimistic speech of the noble Lord, Lord Paul. I hope that I can follow in the same spirit.
	Today's is a debate on sport with special reference to the Olympic bid. I congratulate my noble friend Lord Monro of Langholm not only on securing the debate on a subject that he has made very much his own and on the manner in which he opened the debate, but also on his impeccable timing. He sat on the Conservative Front Bench in the Commons both in government and opposition for more than half his 33 years in the other place, and he served most of that time either as sports Minister or as the opposition spokesman on sport for a whole Parliament. His interests in particular sports are manifold, as he has demonstrated today. He has done your Lordships' House and, indeed, sport a very notable service today.
	Around the turn of the 19th century into the 20th, Arthur Quiller-Couch wrote a notable parody of Browning's poem, "How We Brought the Good News from Ghent to Aix" in the form of an account of how the horse, Wooden Spoon, John Jones up, won the Jubilee Cup. Like Browning's it is a narrative poem with John Jones as the narrator, but it is a marvellous farrago and gallimaufry of sporting reference. I quote a verse at random:
	"The Lascar made the running but he didn't amount too much,
	For Old Oom Paul was quick on the ball, and headed it back to touch;
	And the whole first flight led off with the right as The Saint took up the pace
	And drove it clean to the putting green, and trumped it there with an ace".
	It serves as a paradigm for today's debate both because, like today, it embraces all sport but also because the steeplechase it recounts is not dissimilar to the exhilarating, oscillating ride the Government have in mounting the London Olympic bid.
	Like many in your Lordships' House, I am old enough to remember the 1948 Olympics, the year of Fanny Blankers-Koen and Emil Zatopek. Our own team had roots in the multifariousness of sports which Quiller-Couch celebrated and which we debate today. Our entry in the 100 metres final, Alastair McCorquodale, had opened the bowling for Harrow against Eton at Lord's. C B Holmes, who I watched play wing three-quarter to dramatic effect for England v Scotland in the first Calcutta Cup Match at Twickenham after the war in the snow was, as I recall, certainly in our sprint relay team and may have been in the 200 metres relay final as well.
	I had myself urged once in Cabinet Committee that we should go for the 2008 Games not only because of its being the centenary of our first Games but also because of the remarkable conclusion to the Olympic Marathon that year. No doubt dithering about Crossrail would have been as much a problem then as now—and I acknowledge, of course, the part played by the anti-Crossrail lobbying group from Tower Hamlets in the Private Bill Committee upstairs in the other place. But even with the extra four years we have not so far got our act together.
	I dare say that the Minister in reply will reasonably play the card of yoking the Government's predecessors in the dock with the present Government; but this administration has now been in office for seven years and no one could possibly say that the past seven years have been used to the best possible advantage on the Underground, either for the good of Londoners or for the good of this bid. If the Minister exculpates the Government and transfers the blame to the Mayor, the latter is not only the creature of this Government in legislative terms, but has been invited back into the bosom of the Labour Party on the strength of his performance of his first four years in office.
	All of that, however, is in the past. We are now in the present and what we need to know now is how the Government are going to put on a catch-up act, not only to eliminate the margin behind Paris and Madrid, but then to surpass them. I remark neutrally that I am glad that the hotels of my former constituency and of neighbouring ones are level-pegging already with those of Madrid and Paris. It is critical that the Government should put out of their minds any idea that the tombstone to our bid should bear the word "IRAQ", even though of course preoccupation with Iraq held up Cabinet consideration of the bid in early 2003. If we set out with a sour grapes scenario, we shall fail; and that failure will be more serious because it will weaken our resolve in Iraq as well. If we believe in the Iraq policy, a measure of that belief will be the conviction behind this bid. We await the Minister's reply with interest.
	Because the debate is wider than just the bid, I want to raise three other matters. The first is the Government's recent revisiting of our overall national failure to achieve five half-hour periods of physical activity each week. That was a recommendation derived from the Government's 1998 Acheson report on health inequality, which found that 75 per cent of women and 63 per cent of men failed those minimum guidelines. Two weeks ago the noble Lord, Lord Rooker, teased by my noble friend Lady Hanham in a Labour debate on central government help for local communities by drawing attention to the absence of Conservative speakers in the debate, apart from herself. That was the only Wednesday in the past four weeks in which I did not speak in both debates; so let me make amends now with a quotation from the King's Fund's Five Year Health Check of April 2002:
	"In summary, Labour has stimulated a substantial volume of local and neighbourhood based activities aimed at strengthening communities, improving public services and enhancing the quality of life—all of which may help to narrow the 'health gap'. Much of the time, however, its efforts have suffered from a lack of definition and top-level leadership. It has allowed the media to set the health policy and has become trapped by its own rhetoric".
	Given the reiteration over the last month of the targets, it does not sound as though much has changed since 2002.
	My second concern, analogous to the first, is regarding matching funding to local sporting bodies. The Minister and I had the pleasure of attending the anniversary celebrations of Arts and Business at the Barbican, in which he had a starring role. The matching funding success of arts and business since the 1970s stimulated the creation of Sportsmatch in the 1990s. My favourite fact about the parallel Foundation for Sport and the Arts was that, at the celebration of its first £100 million of donations, it announced that its smallest donation had been of £25 to a village cricket club to fill in the rabbit holes on the boundary. Sportsmatch could clearly do even more than it is doing at the moment. My interest, even if the Minister tells me that Sportsmatch is funded through an interim funder with ring-fenced money, is in how the amount that it receives is determined.
	My third concern is that what Ofsted regards as important in youth work can deny voluntary youth clubs funding for their recreational activities from local authorities as being outside Ofsted's purview. I declare an interest as the president of the oldest youth club in the world, which is within half a mile of this palace and which runs a series of teams in a series of sports. An unintended consequence of that non-funding by local authorities of that sort of activity is that the relationship developed between youth workers and their teams, whether football, cricket or basketball, which is often crucial in youth workers imparting lessons about adulthood to their members, is at risk if all funding has to be raised voluntarily.
	In conclusion, I come back to Quiller-Couch's poem. Wooden Spoon has won the Jubilee Cup, as we hope the country will win the Olympic bid; and John Jones' final two verses are:
	"I'm going out with the tide, lad—you'll dig me humble grave
	And whiles you will bring your bride, lad, and your sons if sons you have,
	And there when the dews are weeping, and the echoes murmur PEACE
	And the salt, salt tide comes creeping and covers the popping crease;
	In the hours when the ducks deposit their eggs with a boasted force,
	They'll look and whisper 'How was it?' and you'll take them over the course,
	And your voice will break as you try to speak of the glorious 1st of June,
	When the Jubilee Cup, with John Jones up, was won upon Wooden Spoon".
	Gender suggests that John Jones is either the Minister or the Sports Minister, Mr Caborn. In either case we hope that Quiller-Couch's version has the same happy end to the Olympic story.

Lord Pendry: My Lords, I, too, congratulate the noble Lord, Lord Monro, on securing this debate. Although I did not agree with some of his comments, I welcome any debate on sport in this House and, indeed, in the other place. The matter is not debated enough, as we all know. I recognise the noble Lord as a keen sportsman, an excellent former Minister for Sport and a first class rugby player in his day, so I respect his views enormously.
	I am very pleased that the Opposition have woken up to the fact that we on these Benches have been more dominant in debating sporting issues. It is good to see that there are more Opposition Members in the Chamber today than hitherto has been the case—no doubt due in part to the active whipping of the noble Lord, Lord Moynihan, the Shadow Minister for Sport, who was also an excellent Minister for Sport.
	This debate, of course, is timely, as has been said, as we in this House can congratulate the London 2012 committee on attaining a place for London in the final five of the IOC's candidate cities list. We all recognise that its efforts to date on behalf of those who support London's bid for this most historic and prestigious of games has to be commended.
	It is to the Government's credit that they have taken this bid seriously and are pulling out all the stops to bring about a successful conclusion; not only the Government, because it is heartening to hear that British business is supporting our bid and that is vital to its success. Business has made a good start and I am sure that with yesterday's news there will be an even greater effort from business to assist with funding to secure a successful London bid. Is it not ironic, however, that £1 million from a French-based company, EDF Energy, has been given to the British Olympic Committee? Perhaps that is a good omen.
	Although we can celebrate the successes achieved to date, we have a long way to go before we jump the final hurdle and on to the finishing line. But let me reflect for a moment on what we have going for us. We have many world class venues to accommodate the games, including Wembley—when it is finished—Wimbledon, Lord's, the Dome, the ExCel Centre and many more. Additional venues have also been proposed to the IOC, such as the Olympic park stadium and an Olympic aquatic stadium. Such venues would not only help regenerate east London, but would leave a legacy of quality facilities for our future athletes in years to come.
	So, a solid basis already exists for a number of Olympic competitions. I would like to agree with the noble Lord, Lord Monro, that we should not be playing party games with this bid because all of us should now be backing it to the hilt.
	To that extent I draw the noble Lord's attention to the actions of a Tory council—Westminster Council—and its positive sporting programme, Champion 2012, which allows children to sample coaching in several of the minor Olympic sports, such as judo and table tennis—an opportunity they might otherwise not have had. The approach of investing in our young people is to be commended, and that scheme represents the true spirit of the Olympic movement.
	The talented athletic scholarship scheme, officially launched this month by Secretary of State Tessa Jowell, will go a long way towards creating the real opportunities necessary if we are to keep some of our most promising young talent involved in athletics. The recently launched apprenticeship in sporting excellence—which is currently being rolled out by SkillsActive across football, rugby and golf, ultimately extending to other sports—will also make a great contribution to the nation's sporting skill base. The introduction of the new national coaching qualification by Sport England promises to bring further cohesion and credibility to coaches of all disciplines across 31 sports, building a solid foundation for the delivery of the nation's future sporting excellence.
	It is with all this in mind, as one who been to every Olympic Games since 1972, that I feel very positive about our chances of hosting the 2012 Olympics, and equally positive about our chances of delivering a successful games, should we win that bid.
	Having discussed aspects of the progress of the bid, I turn your Lordships' attention to the part of the Motion that draws attention to the Government's policy on sport in general. Since 1997, admittedly with the assistance of lottery funding—which was, of course, available under the previous government—this Government have invested over £3 billion in the funding of sport. In 2002–03, this worked out at something like £9.30 per head of the UK population. We are ahead of our European neighbours. Germany spent £8 per head, and France only £5.60 per head for the same period.
	If we take local authority spend into account, the UK contribution is estimated to be £23 per head. The Government clearly care deeply about sport, as they invest heavily in it. But that is not just sport for sport's sake. Public funding for sport takes the Government's wider policy aims in health, education and the communities forward. We all know that, in the area of health, inactivity levels are reaching crisis point. In the UK, levels of obesity have trebled over the last two decades. Even modest increases in physical activity, however, have recently been shown to have wide-ranging health benefits. The money being pumped into school sport is showing great improvements in young people's self-esteem, as well as in academic achievement. Game Plan, commissioned by the Prime Minister in December 2002, sets out the future strategic direction of the Government's sports policy. Its recently published delivery report recommends developing the UK's sport and physical activity culture, enhancing international successes, improving our approach to mega-events and major sporting facilities.
	The Government are now using lottery and Exchequer funding to achieve clear and measurable outcomes in key areas. They are raising levels of community participation by investing in high quality local sport and activity resources, available to all. Sport England and the New Opportunities Fund are now putting millions of pounds into local sports facilities to ensure a legacy of activity and engagement in sport.
	At this point, I must declare my interest as president of the Football Foundation. The Government are helping to contribute to the future success of British sport in imaginative ways. The Football Foundation is a true partnership between the Government, the FA and the Premier League, as the House knows, to ensure that football continues its sterling work in sport at grass roots level. The foundation creates the opportunity for all young people to get involved, and stay involved, in football.
	Only last Saturday, I attended the presentation of a cheque for over £500,000 to the Longhill Playing Fields in Hull with the Deputy Prime Minister. That money will provide playing pitches and changing facilities for the next generation of young footballers in the area. Some of you will no doubt have watched television on Monday morning and seen the Deputy Prime Minister showing his dribbling skills to the nation, with kids from his own constituency. I can assure this House that he will not be joining Beckham at Real Madrid, as much as people on the other side of the House may wish that to happen.
	In conclusion, I hope that this debate demonstrates the Government's commitment to sport, in particular within the context of the Motion before us, and their determination to win the bid for the 2012 Olympics for our nation.

Lord Lyell: My Lords, it is a pleasure to follow the noble Lord, Lord Pendry, since we both have a great love of sport. I rise to speak with enormous gratitude, since my noble friend Lord Monro suggested that I add my name to the list of speakers, despite the fact that I notice a great deal of emphasis on 2012 and the Olympic bid. I look down the list and find the noble Lord, Lord Glentoran, who I remember 51 years ago on another playing field, playing under the name of Mr Dixon. His team did not win, but they left a lasting impression on me. I used to see him in the boxing ring, too. I should tell you that he is the same man today, with the same competitive nature. Yet in 1964, he gave me and, I believe, millions of other non-participants, the pleasure of watching a somewhat exotic sport, two-man bobsleigh. It required the same qualities that I knew to exist in him then, and exist today, of participation and sport. I hope he would permit making friends.
	I will leave the Olympic aspect to my noble friend Lord Moynihan and the noble Lord, Lord Glentoran. Sadly, I do not know where the noble Lord, Lord Coe, is. Perhaps he is doing something about 2012. I wish him well, and hope that he will be able to have lasting success there.
	My noble friend Lord Monro spoke about the problems of cricket, the International Cricket Council and touring Zimbabwe. I am sure that my noble friend, and the noble Lord, Lord Moynihan, will tread quietly, watching their toes, when mentioning sport in the arena of politics. Indeed, I think it was probably my noble friend Lord Monro—not the noble Lord, Lord Moynihan, although he was involved in this—who was Minister for Sport when the then Prime Minister, Mrs Thatcher, thought that solidarity should be shown over the Soviet invasion of Afghanistan. I hear murmuring dissent from my noble friend Lord Monro. He probably was the Minister for Sport. What he perhaps does not quite appreciate is that there was considerable difficulty reconciling the views of the Prime Minister with watching our television as a team of college amateurs thrashed the pants—if I may put it that way—off a professional ice hockey team at the 1980 Olympics in Squaw Valley. It was difficult reconciling President Carter's receiving of the American team, and the Olympics, with the disgraceful things that had happened in Afghanistan. I am sure that both my noble friends Lord Moynihan and Lord Monro will reconcile their views. Indeed, I think my noble friend Lord Moynihan has a medal from the 1980 Moscow Olympics.
	What concerns me far more today, however, is the Government's plans for sport. We always love hearing the noble Lord, Lord McIntosh, recall the day in April 2000 when he gave some news—alas, as Time Magazine said, he was "nearly right". He gave the score but the wrong team. That was, I think, when Real Madrid actually beat Manchester. It caused considerable panic in your Lordships' House, and the rending of garments by Black Rod who had been listening to that debate.
	My noble friend Lord Monro raised an important point, when he referred to "volunteers", and what I call "people to supervise". In the late 1970s, the noble Lord, Lord Monro, and I visited the Sobell Sports Centre in Islington, where we met that wonderful gold medallist David Hemery, who was more or less running it. Within 10 years—even within five years—the centre had difficulties. They resulted not from the investment and arrangements made but because not enough men and women gave their time to assist all the participants.
	Sport—even the Olympic Games—is not necessarily about age. Indeed, we can think of elderly people who take part in sport. Your Lordships, even the noble Lord, Lord St John of Bletso, may know that the late Lord Orr-Ewing participated in a complicated skiing slalom at the age of 80. And at the age of 62, Lord Digby was the best British skier two years running. So even at that restricted level, age is no bar to participation.
	My noble friend Lord Monro spoke of achieving the impossible. I thought that, too. Although in 1959 I broke my leg in three places and spent two years in plaster, even I manage to participate in sport. Indeed, in January this year I broke my shoulder for the second time and it is still on the mend. That shows that participation can be dangerous.
	Having put my name down to speak in the debate, I went to my rack and found a note from the Minister's colleague, Mr Caborn. It was an invitation to join the Westminster Mile on 16 June 2004. There are paragraphs inviting us to take part in "movement" through St James's Park. The third paragraph expresses the hope that Roger Bannister will be there to start it off, together with persons such as Steve Cram, Tessa Sanderson, and a gentleman called Gordon Ramsay—I thought that he put weight on you rather than took it off—who will be there to cheer people on. I have a message for the noble Lord, Lord McIntosh of Haringey: "You, too, Minister". I am looking forward to hearing him say that he will be skipping on 16 June.
	Sport exists not only for participation—not just at Olympic standard—but also for watching. It is of great importance. For my noble friends Lord Moynihan and Lord Glentoran, for all sportsmen, and for me, it is for making friends. Nothing has done more for me than sport. I was lucky when crossing Abingdon Green and I heard a television cameraman speaking French. I replied to him in French. I have since struck up a fairly effective working relationship with the French television channel, Antenne 2. In 1996, as a reward for various things I had done, they took me in their car from Dover to Brighton to watch the Tour de France. I read L'Equipe, the daily sporting paper, which does an enormous amount for my French. Your Lordships will know that in the Salisbury Room there are various other foreign newspapers. In them, one can read about Swiss skiing, for instance. There is Gazzetta dello Sport on cycling, which I can understand. And M. Oliver, who used to feed us so well, will be taking no calls as he watches the Giro d'Italia cycle race every day in May.
	Sport can build great relationships. It has done it for me and it does it for countless other young men and women. It is an enormous benefit to us all. You can make lasting friends, whatever standard you are. Indeed, you have only to see the conclusion of the Olympic or Commonwealth Games, or others, to see athletes from all countries mixing together. There is no problem. Occasionally, as in 1972 in Munich, a hideous shadow passes over the games, but I believe those Olympic Games were an enormous success.
	I take little part in sport, apart from a little in Scotland. Indeed, last Saturday, for the 21st year running, I had the good fortune to sponsor my local football team, Forfar Athletic,

Lord Monro of Langholm: Hear, hear!

Lord Lyell: My Lords, I hear noises of assent from my noble friend. There is one noble colleague of whom I hope your Lordships will take note; the noble Lord, Lord Macfarlane of Bearsden. He and his company give enormous support to sport and football at that low level. Every weekend, my noble friend and his wife are at places like Firs Park, East Stirling football ground, Peterhead and Dumbarton. It is not glamorous. And rightly, my noble friend and his company sponsor the Ryder Cup. Enormous support is given not just by those who participate or speak in support in your Lordships' House. I want to pay tribute to what my noble friend Lord Macfarlane does to support sport. For all I know, he may well be assisting with the Olympics. I am not too sure, but he could do that.
	Sport, participating and watching, is an essential part of my life and I give fair warning that I look forward to 16 June 2004. I await the reply of the noble Lord, Lord McIntosh, and look forward to seeing him at No. 10 Downing Street, where I understand the event is due to start.

Lord St John of Bletso: My Lords, it is always a pleasure to follow the noble Lord, Lord Lyell. I am afraid that I do not have such a repertoire of anecdotes of sporting events, but we have a mutual passion for skiing and are members of the all-party parliamentary skiing group.
	I am grateful to the noble Lord, Lord Monro of Langholm, for introducing this topical debate the day after we thankfully have been shortlisted with the last five to stage the Olympic Games in 2012.
	Let me say at the outset that I wholeheartedly support the bid. The 2000 Olympic Games in Sydney raised the stakes and showed the huge benefits of hosting such an event, both financially and in terms of providing improved facilities and infrastructure to promote sport.
	The nature of the challenge is simple: to stage a viable and successful Olympics as opposed to an extravagant and unsuccessful Olympics. I have studied the plans and feel certain that the London team has a good chance and is on the right track. We have a bid strong on technical quality, strong on glamour and strong on proven event experience.
	In bidding for an event of this magnitude, we are investing in Britain's sporting future. The dividends may or may not be paid out in gold medals at future Olympics, but, more importantly, they will be paid out in youngsters who get off the sofa and into exercise and who get out of drugs and crime and into sport. I am pleased that several noble Lords have mentioned not just the importance of sport, but what an important role sport can play in reducing youth crime.
	The Olympics will enhance our status as a top sporting nation and all the available evidence suggests that sporting nations tend to be happier and healthier. Provided that this concerted Olympic bid forms part of a well-funded government sports strategy which ensures that physical education forms part of the national curriculum, encourages more and more adults to take exercise and protects playing fields—mentioned by the noble Lord, Lord Brooke—from development, Britain will prosper from the grass roots right up to élite level.
	Of course, London needs to win what is unfolding as an extremely competitive race. At present, sources within the IOC suggest that London is running a close second behind Paris, with Madrid and New York also strongly in contention.
	An interim IOC report identified two main challenges to face the London Olympic bid team. The first, which was eloquently outlined by the noble Lord, Lord Brooke of Sutton Mandeville, was transport. The bid team must counter any doubts surrounding the city's capacity to transport competitors, officials and spectators between the Olympic village, the venues and the hotel hubs around the city. In practice, that may prove an easier task than moving commuters around on a normal working day because, effectively, the Olympics will last for only two weeks. Dedicated lanes for accredited Olympic traffic will mean two weeks of disruption for Londoners, but the city will survive the nuisance; and a planned east-west rail link will move people from the main Olympic precinct into the West End in just seven minutes. In short, the transport problems can be solved—if not for posterity, then certainly for a fortnight.
	The second challenge is to deal with the single greatest threat to the British bid—that is, public apathy. Too many people appear detached, disinterested or plainly opposed. In letters columns, on radio phone-in shows and in polls to date, too many Londoners talk about the cost of the Games and not the opportunity. The IOC has noticed this point. In its report, each of the five short-listed cities is given a mark out of 10 to reflect levels of public support. London, sadly, is ranked fifth out of five—stone last, with a score of 5.4. Such shortcomings are potentially fatal to London's chances of winning the vote in July 2005. The IOC wants nothing more than to award the Games to a city whose citizens genuinely want them. Any sign of indifference or opposition is regarded as a major weakness.
	So this is the challenge: before they can start winning the votes of the IOC members, the London bid officials must start to win the hearts of their own people. That will not be easy. London's 2012 bid needs to discover a mission, a convincing reason for being and even a rallying cry. The Seoul Olympics of 1988 was cast as the platform for the modernisation of South Korea. Barcelona in 1992 became a vehicle to transform a grim city into one of the most glamorous destinations in Europe. Atlanta in 1996 was portrayed as the model of capitalist enterprise. Sydney in 2000 became the athletes' Games, characterised by Australian cheer and fantastic hospitality. Athens in 2004 offers the prospect of bringing the Games home, back to its purest ancient roots. And Beijing in 2008 won appeal as a great leap forward for China, offering access to a vast, untapped market.
	So what is the reason for London 2012? What is written on the banner under which people will be asked to come together in favour of our bid? Perhaps it is this: London is surely the most cosmopolitan city in the world—a melting pot where all languages are spoken, all cultures nurtured and all creeds followed. Perhaps in an increasingly divided era, London 2012 can become a demonstration of global unity—a true world Games in what is a true world city.
	If we combine that with cast-iron evidence that the Olympics will leave the city with a greatly improved, modernised transport system, the polls may move. Londoners may start to rally behind their city's bid. At any rate, the stakes are high and the prize is great. If London can show that it really wants the Olympic Games, I believe that London can win the bid to host the Olympic Games in 2012.

Lord Glentoran: My Lords, I thank my noble friend Lord Monro for introducing this debate. I suppose that I should also thank my noble friend Lord Lyell for his comments about me earlier as perhaps they excuse me from declaring any interests.
	I want to start by talking about the bid. We should congratulate the bid team on having got us over the first hurdle. When Barbara Cassani was appointed, I was not 100 per cent satisfied that she was, indeed, the right person for the post. However, she has clearly done a superb job in getting the bid team up and running with some momentum.
	At lunchtime today—this has not been mentioned by other noble Lords—I was interested to see on the one o'clock news that Mrs Cassani has resigned as chairman of the bid team, although I understand that she will stay on as a vice-chairman, and that my noble friend Lord Coe has taken on the chair. Although I have not had very much time to think about it, that sounds to me a clever move. The business of getting a serious project under way, up and running and sorted out requires a tough and experienced business person. Barbara Cassani is certainly that and she has certainly achieved in that respect.
	I believe that the name of the game has now changed somewhat. There is momentum and we are starting to move into the final part of the race. Diplomacy, how well known one is and all that goes with being an Olympic personality, as my noble friend is, must be a bonus. I hope that it will prove to be a clever move which is supported by everyone. My noble friend has influence and knows all the people and all the ins and outs of Olympic politics. And, my goodness, there are politics with a small "p" and a big "P" in and behind many scenes in this type of game, as I suspect most of your Lordships will be aware. Seb Coe, if I may refer to him as that, has been there, he has seen it all, he knows the people concerned and he should be able to provide us with an excellent opportunity. However, it is vitally important that the environment out of which he operates works smoothly and well and that his support is seen to be firmly in place.
	We have got over the first hurdle as a serious competitor, but I would not say that we have done so very satisfactorily. We just about came second, or perhaps third according to some scoring. However, I understand from information that I obtained from the Internet that the latest odds for 2012 are: Paris, 11/10; London, 5/4; Madrid, 7/1; New York, 8/1; and Moscow, 20/1. Therefore, the competition is tight and we are in there.
	We must also be aware—the Government have a role to play in this—that every major sporting event that takes place in this country over the next nine months will be under the spotlight. That includes the behaviour of crowds at football matches, political demonstrations, the risk of terrorism and how we manage those situations. It includes how we manage our security, how we manage our behaviours and how we manage any major events that we may have, including enormous football matches and perhaps cricket matches and other events over the course of the next few months.
	I turn—this has already been mentioned by noble Lords—to the transport situation. I suggest that it has been spelt out to us in words of one syllable. Something must be done and plans must be put in place—and very quickly because they have to be announced soon. I believe that we have only 363 days in which to convince the IOC that everything is in place and that we can make it all happen.
	One area about which I feel particularly strongly and about which the noble Lord, Lord St John of Bletso, talked very eloquently—it is certainly one of my bullet points—is the attitude of Londoners. Like most noble Lords I spend most of my week here and I feel that at the moment London is not turned on by the bid; it is not behind the bid. If we are to have a hope on earth of winning the bid, London has to be motivated behind it. I do not know how we do that. There was a time when the Government had a very good spinning and PR machine. Let us rediscover it, turn it on and link it to Mr Livingstone, London's Mayor. Let us make it work. If we are not turned on, and we do not get the people of London hyped up about it, we shall not have the Olympics here in 2012.
	We also need to make the point that this is a national event. I know that the Olympic Games are awarded to a city, but in a country the size of the United Kingdom the games will take place all over the kingdom. Preliminary matches and knock-out matches will take place in Belfast, Edinburgh and Cardiff; lakes, mountains, roads, tracks and stadiums will be used all over our nation; and teams will come here a year before to train.
	We should not lose sight of the fact that it will be a very big national event, so I see no reason why Londoners should have to pay for it all. That would not make sense. I would have thought that the quickest way to turn Londoners off would be to tell them how much it will cost them. The noble Lord, Lord St John of Bletso, has already made that point very strongly. One can be absolutely certain that Londoners will not be turned on by the rates being loaded for the next 10 years.
	However, in order to get the matter right from now on, a balance has to be struck. I believe that the team has a balance of international diplomacy, politics and good project management. There is every chance that, if London can be turned on and if the funding is put in place in a sensible way so that it does not offend people and does not turn off the nation, we shall win the bid. I am not telling the Government how to do it, but they do not have many options. From the way I am speaking, I hope that noble Lords sense that I am right behind it.
	The debate is also about other areas of sport. Every time I speak on sport I mention my pet subjects, one of which is still in the headlines—nothing seems to have changed—that is, obesity. Little appears to be happening about obesity from the recreational sport end. That links directly into PE in schools. I believe that only 50 per cent of schools include more than two hours a week of exercise. In my day, certainly most schools in the countryside—I do not know about inner-city schools—had some form of exercise every day. In Northern Ireland children had far more than that because they walked to school, often up to eight miles. Many of us walked or ran a long way. In my house at Eton if you did not exercise every day you had your backside beaten and you could not sit on it for the next day or two. I strongly believe that the Government need to get the education curriculum changed. More organised and compulsory recreation and PE is needed in the system.
	We have heard from the noble Lord, Lord Pendry, who has been a good friend of mine for a long time, particularly where sport is concerned. He spoke about all the good things that the Government have done for sport recently and the fact that they have put much money into sport. I am not sure that they have always put it in the right places. Sport is still ground down by too much bureaucracy, too much regulation, too many levels of local government and goodness knows what else. Small sports clubs and organisations have to spend ages filling in forms to access the money. Too many wages are being paid out of it and, in my opinion, not enough money goes to the right places.
	Lastly, I mention the funding of elite sport. As has already been mentioned, before the last Olympic Games a large sum of money from the Lottery went into elite sport. The Lottery is not doing as well as it has done and elite sport still urgently needs money, as it always has done. I remember in 1968 meeting Menzies Campbell, MP, when he and I sat down to try to spread £1 million among many worthy young athletes who had to walk to training and needed bus fares and so on. Even in those days that paid off and we saw people whom we had helped hit the highlights and start to win medals at international level. Elite sport is a must at all times for any nation, but if we are to be Olympic bidders, if we are to have an Olympic Games here, which I sincerely hope we will, we must not allow the funding for our elite athletes to drop.

Lord Jopling: My Lords, I add my voice to those who have congratulated my noble friend Lord Monro of Langholm on instigating the debate. It gives me an opportunity to say what I have wanted to say for quite a long time. Almost 40 years ago, my noble friend came to work in this building on the same day as I did. He and I have worked in both Houses under various governments and I know of no one who has done more to promote sport in this country than him.
	It is important that we do not confuse sport as an activity with the professional carnival which is the Olympics. I must be frank: I am not particularly enthusiastic about having the Olympic Games in London in 2012. I am one of those who, in the speeches by the noble Lords, Lord St John of Bletso and Lord Glentoran, has been referred to as somewhat indifferent. A few months ago when the first announcement of the London bid was made in this Chamber, I believe I was the only one who expressed any reservations when I said that I would not shed a tear if the Olympic Games bid did not succeed.
	Early in his speech my noble friend Lord Monro said that the bid was something that we all welcome. I have to confess that in a low voice I said, "Oh no we don't", to which one of my noble friends next to me said, "You're quite right". Over the months when I have expressed any reservations about the Olympic Games coming to London in 2012 I have been astonished by the number of people who have said, "I am glad that someone is saying that".
	If we are to make the bid, so be it. However, I believe that it is necessary to point out early on that nowadays to have the Olympic Games almost anywhere is a sure recipe for bombs, bullets, bloodshed, boycott, blackmail and bogus budgets. It amounts to that. But if it is what everyone wants, so be it.
	Reading today's newspapers I see that it is true that the IOC is not especially enthusiastic about London. It demonstrated that from its own survey: only 62 per cent of London's citizens expressed themselves in favour of London being the venue in 2012. My guess is that that figure will be dramatically reduced when the penny drops and the citizens of London realise that they will have to find £652 million of the projected budget of £2.375 billion of which the London Development Agency will find another £250 million with the balance made up by £1.5 billion from the National Lottery, a good deal of which will be raised by the poor old citizens of London once more.
	I have asked a raft of questions over the past few weeks on this topic. The Government tell us that there are no special plans for Londoners to have preferential rights to tickets, having paid the bulk of the money to have the events in London. That seems a little unreasonable. The situation for Londoners is all pay and no gain. Many people have suggested that the budget of £2.375 billion is very likely to be doubled. I am interested to know what would happen if that budget were doubled and another £2.375 billion had to be found. In a Written Answer to me on 5 April, the noble Lord, Lord McIntosh of Haringey, said,
	"the Government, as stated in the memorandum of understanding and reiterated in a departmental minute presented to Parliament on 2 December 2003, have given a commitment to be the ultimate guarantor for the Games. On current contingency plans, the Government would expect to discharge this responsibility, should it arise, in a sharing arrangement to be agreed as appropriate with the Mayor of London and for their part seeking additional National Lottery funding".—[Official Report, 5/4/04; col. WA 215.]
	So if the budget doubles, which a good many people have been saying, and the noble Lord, Lord Moynihan, suggested in Committee on the Lottery Bill, as I recall, then the poor old citizens of London will again have to put their hands in their pockets in order to honour what amounts to a blank cheque.
	The Government are supporting the bid for 2012, but they are not proposing to put their hand in their own pocket in order to finance it. I do not believe that that is fair to London ratepayers. It is hardly surprising that there is little enthusiasm, or a good deal of apathy, referred to by noble Lords of whom I spoke earlier, among the people of London. For many years the citizens of London will be charged an extra £13 to £40 per year on their council tax. If there is a 100 per cent overrun those figures will increase to £26 to £80 per year for many years for Londoners.
	The truth of the matter is that only a few of the citizens of London will see the events. If they bother to go, some will be able to see something like the marathon, but it will be a fairly expensive outing for those people who merely go to watch that and do not buy tickets to attend the various events. For the huge majority of Londoners who will watch most, parts of, or none of the events on television, it will not much matter whether the Games are in London, Paris, Madrid, New York or Moscow.
	It is quite right for noble Lords to ask what is wanted if one does not like the present arrangements. I believe that the funding for the bid should be raised nationally on all ratepayers throughout the country. I believe that the existing arrangements are wholly unfair. It would be much fairer and more equitable if that happened. Surely it is not too late to change the funding of the bid and to make it fairer to the people of London.

Lord Addington: My Lords, we owe the noble Lord, Lord Monro, a considerable vote of thanks not only for raising the subject, but also for doing so at a very apposite time. The noble Lord, Lord Glentoran, said that we have got over the first hurdle. We could have done so in a slightly neater fashion, but we are over the other side and that is the important part. The expressions of relief by Barbara Cassani are getting through and they are appropriate. We should have done it. London, one of the world's greatest and most historic of cities, should be capable of getting through.
	The noble Lord, Lord Jopling, has kindly spoken from behind me as opposed to slightly further along the Bench. He has done us a service in pointing out that it is not just a question of us having done well and that it is going to be a great event. There is a definite note of, "We don't want it here if it's going to cost us any money". The noble Lord, Lord St John of Bletso, said that unless that is countered fast we will effectively strangle the whole business with the rope of apathy. We must guard against that very strongly. Without enthusiasm the project is ultimately doomed even if we win the bid. Everything will go off half-cock. We must make sure that support is there.
	As the noble Lord, Lord Jopling, pointed out, there is the perception that one is paying and not getting a lot back. I believe that that is wrong. There is the redevelopment of the East End which is surely worth having. There is the spectacle and romance of the Olympic Games, which is the greatest gathering together on earth of nations in one city. That has to be worth something.
	In practical terms not only London will be involved; it cannot be so. London dominates England, and particularly the south-east, in a way which very few other cities do to the country around them. The financial benefit will go further. As regards the sporting structure, the preparation camps and training facilities will benefit from having the improved infrastructure here in London. There are business opportunities as well as social infrastructure benefits in having the games here. That is not being shouted about very clearly.
	If we are going to pick holes in the Government, from what we have heard today we should have a transport Minister here. We know that the noble Lord, Lord McIntosh, wears many hats with a degree of comfort. I took forward to the Minister telling us exactly what the Government propose to ensure that transport is in place, or at the very least that the perception is going to be good enough for a successful bid. This opportunity will not occur again for some time and many of us in this Chamber will not see it. We must get it right now.
	We should think about spreading the financial burden somewhat. If the Government require extra transport infrastructure, the Treasury pocket is the only one deep enough to do anything about it quickly. We must look at the options.
	To move slightly further away from the Olympic bid for London and to the general tone about sport in this debate, the Government need to give more information about the infrastructure.
	The noble Lord, Lord Monro, spoke about the problem of playing fields—every fox that I had was shot in the course of the debate. Last time there was a Question about playing fields in this House, it was a wonderful plant given to the noble Lord, Lord McIntosh, which was fertilised and watered by his own Benches. The general thrust of it was that the money was being used for other sporting activities. That is possibly the case; perhaps the Government had got their act together at last.
	It turned out that it was 90 per cent of the money from, if I remember correctly, school playing fields, and the other 10 per cent was going on something else. OK, 90 per cent going back in is better than it was; we can argue about the other 10 per cent later, but that does not answer a series of questions. If we want greater participation rates and are to invent targets for participation, do the Government have a strategy that says what that means in terms of playing fields for participation and sport?
	To put it bluntly, if 34 teams in a Sunday League want to play football on a weekend, we will need exactly half that number of pitches available on a Sunday morning. The fact that there is a wonderful training facility is of no use to them on that Sunday morning. It does not make a blind bit of difference. There may be a wonderful sports hall around there, but they cannot get the time off or bring themselves together. Five-a-side tournaments will thrive, but those playing in the 11-a-side game, around which the game is built, will not get their match. They need those 17 pitches. That was lacking from that Answer.
	Do the Government have an idea of how many usable sports pitches they need—what amount of usable turf; that rare commodity around our urban areas, well drained solid bits of turf, which can be used for dozens of different sports? I have had it explained to me that hockey players like to play hockey on new, artificial pitches. That is great if they can all get there. They cannot all get there after work. If they have only the one pitch, with the best will in the world, they cannot get everyone playing on it at once. People are available to take part in sport only at certain times. Have the Government seriously addressed what they want and need in that department? Participation rates require opportunity.
	We have covered up the need to have that organised infrastructure in British sport by the great use of small clubs that buy their own grounds. That has covered up what we can do. The Government have made moves—they have been nudged towards them. It is a pity that my noble friend Lord Phillips of Sudbury is not here to bask in a little of his well won glory. We have made life a little easier for them. But the fact is that if we are to increase participation rates, we need a lot of facilities available when people need to use them.
	It does not help if we have only a few shining examples, of, say, modern gym culture. The reason that gyms exist is because everyone joins them and no one uses them. That is why they make money; that is why they grow. If everyone turned up to take part, they would not be able to get through the door. We pay a few hundred pounds for our guilt. We say, "I can go at some point", but no one does. If we build institutions within local authorities that fulfil the same function, we will not address the problem of obesity.
	The idea of getting into competitive sport is that people have an incentive to be there every week. Presumably, that means that they will do some training. That means that a greater amount of activity will probably be involved. There are all the other benefits that come through sport, such as learning to have a sense of self-discipline, commitment to others in team games—indeed, even in a solo sport, one has commitment to the people against whom one is playing. That is an important factor.
	The Government must tell us whether they have addressed that. What is their strategy? The domesday book of sport is apparently to be published in the next few weeks, when we will have a better idea exactly what our sporting facilities are. That means that when I ask my next embarrassing question about how many national health playing fields we have lost, for instance, we can get an answer, rather than simply talking about school playing fields. If we can get an answer, things will start to make sense. At least the answers will all be coming from the same reference books.
	The Government's target is for 70 per cent of people to engage in physical activity five times a week. How does the Minister think that sport will help to achieve that more efficiently? I have heard that ironing counts towards that. Do your Lordships know that extreme ironing is a sport? People go down waterfalls ironing. Next we will have a competition to see who can have the sharpest crease in his shirt in a future Olympics. That will not encourage regular activity. Repackaging vigorous hoovering will not address the fact that we want people to enjoy their exercise, which is the benefit of sport.
	Where is the Government's central thrust? Gimmicks such as that, or the proposition that we are all to do manual jobs again to reduce our waistline, will not help. The Government must get away from such gimmicks and address the sporting part of this whole public health debate more coherently. I must say that all those involved in government have been a little slow about this, although it is not totally down to the Government; it concerns the culture that we have inherited—although the noble Lord, Lord McIntosh, will reply. Unless we can address that problem we will miss many opportunities both at elite level and in participation and public health benefits from sport.

Lord Moynihan: My Lords, I congratulate my noble friend on his characteristically excellent speech opening our debate. I intend to concentrate my remarks on the bid, for one simple reason. Olympic glory represents the pinnacle of sporting achievement. Its attainment requires a partnership between the highly talented athletes who compete and a national sporting infrastructure that allows those athletes to rise to the top because of it, rather than in spite of it. Olympic success requires a dynamic, vibrant, positive and inclusive approach that reaches up from the grass roots of primary schools and after-school clubs to the pinnacle of élite performance. Thus, the Government's strategy for the Olympic bid should represent the whole of their sports policy, from schoolchildren right up to world-class athletes. Today, we are a far cry from that goal.
	This debate is especially timely. As we have already heard, yesterday the IOC formally announced the shortlist of bidding cities for the 2012 Olympic Games. I echo many previous speakers in congratulating the London bid team. In particular, I point out the excellent work that Keith Mills has undertaken in assembling a first-rate, committed, professional and enthusiastic team. As a city, nation, Opposition and Government, we will need to pull out all the stops and work together if London is to win the bid to host the 2012 Olympic and Paralympic Games. It is essential that all-party support for the London 2012 bid remains strong.
	Let us be clear about one thing. There are no prizes for second place in this competition. The British Government must now begin the process of demonstrating to the world their wholehearted support for London to stage the Olympic and Paralympic Games. From the Prime Minister down, the Government must join us to take every opportunity to showcase Britain as the host nation and London as the host city. On the national level, their work in that direction has been weak, uncertain and lacking in demonstrable commitment. This is the ideal opportunity for the Prime Minister to stand by his famous words and prove that he has no reverse gear. Now it is absolutely the time to step up a gear.
	To use a sporting metaphor, while the bid team has been busting a gut to produce a gold medal bid, the Government, through their lengthy initial delays and subsequent performance, have at best been lukewarm and lacklustre in their support. No one can skip the hours, days and weeks of winter training and expect gold. That is especially true in the case of a government whose international popularity is low and who are up against the total commitment of the Spanish and French political leaders.
	To continue the metaphor, if I were the chairman of the London bid and my team of Ministers had walked into the changing rooms trailing all the bidding cities 8–1 at half-time, as was stated by the IOC yesterday, I fear that my team talk would be unprintable. For on the criterion of government support—public opinion comprises only 15 per cent of that score; that is how political a bid is—we lay eighth out of nine, behind Madrid and Paris and even behind Leipzig, Moscow and Havana. On infrastructure and transport, we lie third and fourth. We lead on only one issue, on which it has been pointed out that the Government have no involvement; namely, accommodation and hotels.
	However, after a few well-chosen words, I would be upbeat. Why? Like my noble friend Lord Coe, whose unstinting work for the bid remains laudable—whom we wish well now that he has taken over from Barbara Cassani as chairman of the bid—I passionately believe in our case for winning this prize. I shall do all in my power to motivate the Government to raise their game. I genuinely believe that they can if they want to. But we need a sea change in attitude from the Chancellor, the Treasury team and everyone involved in international relations, transport and infrastructure.
	The Prime Minister has often displayed passionate and messianic verve when he believes in something. Now is the time for him to lead from the front, shoulder to shoulder with Ken Livingstone and, indeed, Steve Norris after next month, and to demand a far higher level of active and unremitting support from his ministerial team.
	Security will be a major factor in the decision on who hosts the 2012 Olympic Games. The UK leads in that area. Perhaps I may give an example. Security is an issue that the Greek Government have actively sought to address. Under their auspices an Olympic advisory group on security planning has been set up, which is made up of representatives from seven countries. That group is chaired by none other than the assistant police commissioner and head of special operations at Scotland Yard, David Veness. This UK-led group draws on the expertise of its membership from Israel, the United States, France, Germany, Australia and Spain.
	On a fact-finding visit to Athens last week, I learnt from Ministers that the security budget for the 2004 Olympic Games currently stands at £675 million, which is triple the amount that was spent in Sydney. The IOC is known for its caution, and rightly so. It is satisfied that everything possible is being done in Athens to ensure adequate and appropriate security. That confidence speaks volumes. The IOC cannot afford to be implicated in any kind of security lapse at these or any other Olympic Games.
	British involvement is at the very heart of the Athenian security operation. A safe and smoothly-run games will significantly increase our chances of securing the 2012 Olympic Games for London. If the Greek Government maintain their current level of security awareness and if international support is forthcoming, I have no doubt that in August a trouble-free Olympic Games will be delivered. Its legacy will benefit us all for years to come, not least in terms of the London bid.
	Transport is an area where we desperately need to improve our standing, as was made self evident by the IOC. The IOC ranked London fourth on transport. We must deliver the promised East London Line extension, upgrade the Jubilee Line and, with all-party support, give fresh impetus to Crossrail before we can be confident that the criticism levelled by the IOC at our transport policy yesterday can be overcome.
	Critically, the Government, by the actions that I have outlined, must ensure that London and Londoners have ownership of that bid, particularly after the IOC found only 67 per cent support for the bid among London residents. It is essential that all Londoners feel the benefit of hosting the Games.
	To date, the Government and the 2012 Committee have focused on touring the regions to outline the benefits to those regions. Indeed, such benefits are manifold. But it is Londoners who are being asked by Government to foot the bill, not only for the sites in London, but also for the rowing and flat-water canoeing events at Dorney Lake in Eton; for the shooting events at Bisley; for mountain biking at Swinley Forest; for sailing in Weymouth; and for the use of football venues from Glasgow to Cardiff to Newcastle to Belfast, for which the local residents will pay nothing.
	If Londoners are to be asked to pay for all of that at an annual cost of up to £40 a head for the foreseeable future, the Government must demonstrate tangible benefits for them. That is all the more important when, as has been pointed out, the Treasury has designed a formula that demands additional precepts on Londoners for every pound overspend. There has never been an Olympic Games in the modern era which has not been overspent.
	When that was discussed in detail at a meeting with the Minister for Sport on 5 May, he told us that the rate precept formula for Londoners was a "discipline" on Londoners. The idea that the Government need to discipline Londoners is unacceptable. Together—as the noble Lord, Lord St John of Bletso, stated—we need to win the hearts and minds of Londoners, not to discipline them through open-ended precepts when the Treasury is paying nothing towards the cost of staging the Games.
	I appreciate that the current Minister for Sport is from Sheffield. Surely he has learnt from the experience of the Sheffield student games in 1991, which is still costing the local taxpayers more than £20 million a year. When asked about this aspect of the Olympic bid, the leader of the Conservative Party, Michael Howard, said:
	"To describe Gordon Brown as a little half hearted is possibly a compliment".
	The current position of the Government is clear. In the event of any overrun in costs, the extra money will be raised through a split between the lottery, the GLA and the London council tax payer. As my noble friend Lord Jopling said, there will not be just one hit on the lottery and Londoners, but a potentially unlimited number of hits. The funding formula for the bid must be reviewed. We stand ready to sit down with the Government to find an equitable solution.
	For our part, the Conservative Party has already made a number of commitments to reduce the likelihood of a Government raid on the lottery or on the pockets of London council tax payers. By diverting the tax take on the sale of the hypothecated Olympic lottery tickets, we would raise an extra £340 million, which would be paid directly from the Treasury to the Games. Such is our commitment to bring the Games to London. I call on the Minister to match our commitment to ensure that the tax revenue generated for the Exchequer from the new Olympic lottery game is diverted to the London Olympics where it belongs.
	We should never forget that the Games are for the athletes, as Athens is demonstrating so ably in preparation for August. For the UK, it is essential that our Olympic bid is backed by a radical new sports policy. There is little point in seeking to host the Olympic Games in 2012 if our Olympic and Paralympic athletes are ill-prepared to deliver medals. We consistently need an eight-year plan, which would cover the cycles of two Olympic Games. School sport, playing fields and community clubs across the country must not be allowed to wither on the vine.
	The National Lottery, which was introduced by John Major in 1995, revolutionised funding for sport in this country. The record lottery investment in élite athletes produced one of our best ever Olympic and Paralympic Games in Sydney in 2000. Yet the Government still have a key role to play in establishing expectations and defining priority given to sport.
	It is a telling statistic that some two-thirds of our Olympic medal winners in Sydney in 2000 came from the 8 per cent of our schools that are private. In September 2000, we had the very welcome announcement by the Prime Minister that £750 million of lottery money was to be spent improving state school sporting facilities. Yet, after three-and-a-half years, just £10 million of that £750 million has been spent.
	All that time, child obesity is increasing to a record level and the amount of time that is spent on PE and school sport in primary schools has long been, and continues to be, a cause for grave concern. Even in the Government's flagship school-sport partnerships, just 51 per cent of pupils get the minimum two hours a week: only part of that is spent on physical exercise, the rest is in the classroom. That is a very serious issue, which does our Olympic aspirations no favours. However, the Government have the time to act and to raise their game. We stand ready to support them when they do.
	Even when the Government spend money, it is not all plain sailing. The Minister for Sport admitted that in another place when he said:
	"We have spent just over £1.5 billion during the period of the lottery"—
	I repeat, £1.5 billion during the period of the lottery—
	"and have increased participation by just 0.3 per cent. One has to start looking at where things have gone wrong".—[Official Report, Commons, 13/4/04; col. 247WH.]
	He is absolutely right.
	As we have heard already, the case for restructuring the delivery mechanism to our governing bodies and to the sportsmen and women that they represent is urgent. A national system is needed to identify the sporting talent in all our children and a support structure to nurture and develop that talent. We strive for that goal in academia. We have a duty to strive for that goal in sport too.
	In conclusion, there remains much work to be done in bringing the Olympic and Paralympic Games to London in 2012. The fundamentals are in place. The bid team is doing a great job. The House continues to encourage and support the bid. However, it is right that today we take notice—not of Conservative Party views or politicians' views inside or outside this House—of the IOC report. To come eighth out of nine in the criteria of government support, legal issues and public opinion is unacceptable. Now is the time for each and every Minister, from the Minister for Sport up to the Prime Minister, to face up to that half-time rap over the knuckles and to go back out and win the bid for London.
	This is the moment for the Government to demonstrate that they have the stamina, the staying power and the determination to win the race ahead, and to bring the world's greatest sporting event back to this country. When we last held them, we topped the world rankings for government support, as the one country committed to hosting the post-war games. If we think in those terms, I firmly believe that we have the team, the talent, the enthusiasm and the ability to bring the games to London once again.

Lord McIntosh of Haringey: My Lords, I join with all other noble Lords who have expressed their gratitude to the noble Lord, Lord Monro, for finding this opportunity to debate sporting issues. I congratulate him, as others have, on his excellent timing, in that he added the London Olympic bid to the subject for debate precisely a day after the announcement that we had been successful in what has been described as the "first hurdle".
	I am grateful for the expressions of support from everybody—except of course the noble Lord, Lord Jopling— for our bid for the Olympic Games. I am grateful for a very large amount of what has been said in this debate, because there has been a degree of unanimity and common purpose, which is immensely encouraging. The only issue—other than the views of the noble Lord, Lord Jopling, of course—about which I am a little nervous is the challenge set for me by the noble Lord, Lord Lyell, to turn up on 16 June and "skip" a mile from No. 10 Downing Street. Since he will know that I am already under pressure from Richard Caborn, I shall have to think of some very good excuses to be somewhere else on 16 June if I am going to maintain my reputation in this House as a sporting atheist.
	However, that does not mean that there are not serious issues of public policy to be debated. Those issues have been debated with an excellent degree of knowledge, understanding and good humour. When the noble Lord, Lord Moynihan, disparaged the Government's commitment to sport and to the Olympic Games in his closing remarks, he should have recognised that although Londoners are indeed significantly sceptical, as they are on a large number of issues, the Olympic committee concluded that all of the five candidate cities are either 0.8 or 0.9 in government support. There is no significant difference between us. There is indeed a difference in public support in London. The noble Lords, Lord Glentoran and Lord St John, among others, were right to say that one of the objectives of the 2012 committee in the coming months and years—particularly in the coming months—will be to enthuse Londoners and to rouse them from what I would call their scepticism rather than apathy. Even so, it is fair to remark that Londoners' support for the Olympic Games is 67 to 13. That is a five-to-one ratio in favour. There are not many public policy objectives that enjoy that degree of support in this country at this time.
	I shall of course say something about the more general sporting issues that have been debated, but I sense that the House really wants to speak more about the Olympic Games than about the other sporting issues, which have been debated before and can be debated again. At the heart of our Olympic bid is the Government's belief that sport is good for communities, good for individuals and good for the country. It is a good health policy; it is a good education policy; and it is a good anti-crime policy. The Government have invested more than £3 billion of government and lottery money in sport since 1997. The noble Lord, Lord Addington, doubted whether there was a vision or strategy. We have a clear strategy for achieving a fitter nation and world-class success. I could send him a pile of documents in evidence, but I can do better than that. I can indicate the effect that those documents have had.

Lord Addington: My Lords, that is just it; there are piles of documents but there is not one précis.

Lord McIntosh of Haringey: My Lords, the more I stand at this Dispatch Box and the more I sit in government, the more I am sceptical about the ability of White Papers to achieve anything. I worry about documents being an end product rather than an indication of what we actually do. Instead of sending him documents, I shall send the noble Lord, Lord Addington, some of the statistical analyses.
	Of course, participation in physical activity is incredibly difficult to achieve. That really would be turning the proverbial tanker. With almost all of our population engaged in non-manual work nowadays, with individual transport in the form of the motor car being more widely available than it has been before and even with public transport improving rather rapidly, certainly in London, participation in physical activity in this country is far too low. Yes, we know that, and we know that levels of obesity are rising. Even so, physical activity is not all about organised sport. The Department of Health recommends five sessions of 30 minutes' activity a week. The percentage of people who meet that ideal falls from a very low base as people grow older: 41 per cent of those aged 16 to 34; 34 per cent of those aged 35 to 59; and 13 per cent of those over 60. A very high proportion of people achieves only one session of physical activity a week. The noble Lord, Lord Addington, teased me about ironing and hoovering, but he should have a little respect for his elders and realise that active sport is not necessarily appropriate as one reaches 60 or above, even for those who have been very active in sports in younger years. The department's recommendation is very difficult to achieve, but there can be no doubt about the Government's commitment, in terms of both health and sporting objectives, to work towards it.
	There has been unprecedented investment in facilities. Nearly £700 million has been poured into school and community sports through the New Opportunities Fund and Sport England, and 62 per cent of pupils now spend at least two hours a week on PE. I listened with a slight shudder to the reminiscences of the noble Lord, Lord Glentoran, about his schooldays, but 96 per cent of schools held at least one sports day last year—which perhaps makes one wonder what the other 4 per cent were doing.
	In general, I therefore resist the view that there is government inactivity or any failure of investment in sport by the Government during our period in office. The noble Lord, Lord Addington, asked for evidence of those achievements. There is of course the sport domesday book project. Sport England's "Active Cases" website will be live this summer, as the noble Lord said. That will enable citizens to know what facilities are available in their area. That will make a rather important contribution.
	There were conflicting views about government support for élite sport. The noble Lord, Lord Glentoran, thought that the lottery was doing less than it should. He also thought—wrongly, I am happy to say—that the returns to the lottery were decreasing. It looks as if the lottery has turned a corner this year, and receipts are rising again.
	I was grateful to the noble Lord, Lord Moynihan, for his tribute to what has been done in support of élite sport, and we look forward to achievement in Athens from that activity.
	I am sorry that we have to go through the same argument about playing fields again with the noble Lord, Lord Monro. There were 800 approvals for playing field applications in 2002–03, but there are huge gains for sport within those approvals, with the planned development of 489 new facilities leading to a proposed investment of £286 million. I do not think that there have been any fudges, as the noble Lord said, in answers that I have given to Written or oral Questions. The record on retaining playing fields is excellent, and I shall not weary the House by contrasting it with that of the previous administration.
	I was grateful to the noble Lord, Lord Brooke, for what he said about private sector contributions to sport, particularly to grass-roots sport. The concentration by Sport England on grass-roots sport and the work of, for example, Sportsmatch, which has had £3.675 million from DCMS—all of which has been matched from the private sector—is very valuable.
	I have spent far too long before getting on to the Olympic Games. I hope that noble Lords will forgive me—I will now move straight on to that issue. There has been virtual unanimity on the London Olympic bid, which is enormously gratifying. The bidding company has recruited a high quality team; we have met the deadlines and have come through the first hurdle. There must be another way of saying that—we have come over the first hurdle. I shall always be caught out even worse than Sir Arthur Quiller-Couch if I attempt sporting metaphors. They will always be mixed metaphors when they come from me.
	There is still some misunderstanding about the difference between the UK-wide benefits of hosting the Olympics and the benefits for London. Of course there are very significant UK-wide benefits. As has been said, many of the events in the London Olympics will be in other parts of the country, and people in other parts of the country will benefit from those directly and from coming to London. However, the regeneration benefits—the long-term legacy—will be particularly enduring for London because many of the new facilities will be provided in London.
	We think that there is a very proper balance between what London is contributing through the council tax—a figure of £625 million over 10 years—what is to be contributed by the London Development Agency and what is to be contributed from nationwide lottery funds. I hasten to say that the £2,375 million we are talking about is not a budget. People talk as if it were, but it is the sum of the public subsidy which is proposed. Of course, as for all previous Olympics, we anticipate very considerable private support, and we are grateful for that which has already been promised. Of course there will be the income from the activities to be considered. We should look at the issue in that wider sense. When we do, the amount coming from the London council tax seems entirely appropriate.
	I noticed the very wise words of my noble friend Lord Pendry and the noble Lord, Lord Brooke, about who has been contributing private funding. I am grateful to them for that.
	I am glad that the noble Lord, Lord Moynihan, has left the debate about the early Olympic lottery until another, more appropriate, occasion, which will no doubt be the Report stage of the Horserace Betting and Olympic Lottery Bill. I will be happy to debate that and the Olympic lottery tax with him then.
	It is appropriate that I conclude by saying something about the events of the last 28 hours, because they have been considerable. It is a tremendous honour that we have been chosen as a candidate city. Reference has been made to the evaluation report which puts London in third place, behind Paris and Madrid, and just ahead of New York. The strength of the London bid, shown in the IOC's evaluation, are a well planned sports concept with the use of 20 existing venues; the Olympic village, with a very good competition environment for the majority of athletes; and the environmental quality of the bid—the Olympic Park area is the largest ever environmental reclamation and transformation project. The evaluation also refers to the availability of accommodation in London. I know that that is not directly to the credit of Government, it is to the credit of London as a vibrant city, but that is, after all, what we are all about, as the noble Lord, Lord St John, rightly said. There is also the financial package in place for the games. I recommend that bit of the IOC's conclusions in particular to the noble Lord, Lord Moynihan.
	We are confident that we will have the capacity to continue to reflect those strengths which are shown by the IOC bid, but also to tackle the weaknesses which are undoubtedly there. I have talked about the scepticism of Londoners. I think that it is within the capability of the bid team and particularly of the noble Lord, Lord Coe, as its new chair, to build on the excellent work of Barbara Cassani and to enthuse Londoners and the people of this country more widely, as we get closer to the final bid period, about the virtues of the Olympic Games for this country.
	The noble Lord, Lord Glentoran, said that London is not behind the bid. I find that unhelpful and I do not think it is true. It is just that we Londoners have a lot of things on our minds at the moment, and I think that the Olympics will come to the fore in people's views. Certainly there is, as the noble Lords, Lord St John, Lord Glentoran and Lord Addington, said, much to be done on the transport side. But we are confident that London will have the capacity to deliver the transport requirements for the Olympics.
	We already have one of the world's most extensive rail and underground systems. There will be significant improvements to the infrastructure by 2012, not least, as the noble Lord, Lord St John, said, the new link between King's Cross and Stratford that will take passengers into the heart of the Olympic zone from central London in less than seven minutes. We have already planned significant levels of investment in both the Underground and rail transport network to improve safety and capacity.
	I have referred already to the work of Barbara Cassani and to the fact that the noble Lord, Lord Coe, is taking over from her. I am grateful to the noble Lord, Lord Glentoran, for his tribute to Barbara Cassani and his very perceptive analysis of the role that she has played in the early stages; he also discussed the difference between that and the role which the noble Lord, Lord Coe, will be playing as we come closer to the bid deadline.
	We have a serious bid and we are in the running. We have the complete commitment of the Government to that bid; we have the commitment of the Mayor of London to that bid and we will have the commitment of the people of London. The best we can do, I think, is to send off those working on the bid with the rousing support of the House of Lords. I repeat my thanks to the noble Lord, Lord Monro.

Lord Monro of Langholm: My Lords, we have had an excellent debate and I am grateful to the noble Lord, Lord McIntosh, for his good-humoured reply to a good-humoured debate. We have learnt a great deal from it. Speakers from all sides of the House were informed and, with one exception, all wished the bid full steam ahead for 2012.
	What did come out of the debate—I think it originated from the noble Lord, Lord St John—was the concern about apathy. I mentioned that that was part of the concern of the IOC. I hope that the noble Lord, Lord McIntosh, will take the message to his colleagues that we must raise the standard of information and the level of enthusiasm and must consider how we are going to get the result. The sooner that is done, the better. It has to be done by November, when our bid goes in. After that, the door shuts. We must do a great deal in seven months.
	I was disappointed on the issue of playing fields; our statistics differ dramatically. But whatever happens, the Government are agreeing to the change of use of far too many playing fields, which is far removed from their manifesto commitment.
	Lastly, we did not say enough about the lottery. It is incredible how the income of sport has changed since it was introduced. We want to say thank you to John Major and the Conservative Party for bringing it in and at least doubling the amount of money in grants to the various sports bodies in this country.
	All in all, I think that we have had a useful afternoon. I hope that the country will take heart from what we have said and will wish the bid every possible success. I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

HIV/AIDS

Lord Fowler: rose to call attention to the worldwide spread of HIV/AIDS; and to move for Papers.
	My Lords, some people ask why we spend time debating HIV/AIDS when there are so many other medical conditions that demand our attention. I suggest that the answer is threefold. The first reason is the sheer scale of the human tragedy that HIV/AIDS has caused. So far, the total throughout the world is 25 million dead, which is four times the Holocaust and vastly more than the results of terrorism.
	UNAIDS estimates that last year alone there were 3 million deaths, which is the highest-ever total. That figure includes 500,000 children under 15, many of whom had been born with HIV, although we now have the medical means to prevent such mother-to-baby transmission. The year 2003 saw new additions to the vast number of orphans living around the world who have lost both mother and father to this disease.
	The second reason is that the epidemic—the pandemic—is predominantly wiping out young men and young women. They are the men and women nations rely on for their development and are the men and women who should become leaders in business, trade, education, medicine and politics. For example, the pandemic is killing Zambian schoolteachers at twice the rate at which they are being trained. This is not a disease striking at the old and infirm but is an epidemic wiping out the young and the economically active.
	The third reason, and perhaps most ominous one, is that the position throughout the world is not improving but is all too often deteriorating. We may deplore what has happened in the past but, unless we take all the action open to us, there is worse to come. The tragedy is that we have the ability to prevent much of the spread of HIV/AIDS, and to offer hope to those who are already infected, but too often we do not have the will or the determination to act. The best estimate is that today there are 40 million people living with HIV throughout the world. Last year 5 million new men, women and children were infected and 700,000 of those infected were children under 15.
	This is not an epidemic that has been halted; it is an epidemic that is spreading. It now threatens new countries and new generations of young people. The destruction continues. Today the epicentre remains sub-Saharan Africa where last year alone there were 2 million deaths. One prediction that we can make with absolute certainty is that this death toll will continue to rise. There are somewhere between 25 million and 30 million people living with HIV in that area and it is estimated that 3 million to 4 million of them urgently need treatment today. We know that the vast majority of them, about 98 per cent, will not receive such treatment. Anti-retroviral drugs may have reduced deaths in the West—although it should be emphasised that they have not provided a cure—but in Africa such treatment is for a tiny minority.
	However, there is a profound danger in believing that Africa is alone in facing this crisis. No government anywhere in the world can say that it will never happen in their country. At this moment, HIV is taking hold in a range of countries where a few years ago ministers were assuring us that they had no problem. In India, although the official estimate is that today 4.5 million people are living with HIV, the real number is likely to be 6 million to 7 million. Experts in the field say that the Indian epidemic could be devastating unless massive efforts are launched now. In China we know that blood transfusion errors and the use of contaminated equipment by drug-users has helped to lead to a total of at least 1 million living with HIV. Nearer to home, an estimated 1 million people in the Russian Federation are living with HIV. At first, transmission was by the contaminated equipment of drug users but it is now by mainstream heterosexual sex. Drug use is also the entry point elsewhere, as in some countries of central Europe, where it is reported that heroin can sometimes be as cheap as alcohol.
	Let us not believe that the West is in some way immune. There are around 1 million people living with HIV in the United States and some 600,000 in western Europe, including at least 50,000 in the United Kingdom. The latest figures for the United Kingdom were the worst on record. The number of new diagnoses has doubled since only 1998 and, in my view, the Government have done too little to counter this rise and far too little to combat the startling increase in sexual disease generally.
	This takes me to an absolutely fundamental point about combating HIV/AIDS. What is so deeply frustrating and tragic about the figures of death and infection is that so often we know the action that needs to be taken, action which could prevent the disease and action to treat those who are infected. But we also know that first and foremost it is necessary for governments to take the lead. Where governments have done this, as in Uganda, Thailand and Senegal, the harm has been reduced. Where governments have failed to take a lead, their national position has deteriorated and the epidemic has spread. No government can evade its responsibility here.
	We know that sexual behaviour can be influenced. I would claim that our campaign in the United Kingdom in 1986–87 succeeded in reducing HIV and also succeeded in reducing sexually transmitted disease generally. I pay tribute to the support that we received from television companies, radio and newspapers, most of which supported our campaign then and would do so again. I single out the BBC World Service for the extremely good work that it is currently doing in several overseas countries.
	We certainly know from our experience in the UK that clean needles can dramatically improve the position as far as drug users are concerned. To those who say that free needle exchange is too radical, too liberal a step, I reply that it was introduced here not by some way out administration of the left but by the government of Margaret Thatcher. I concede that there were one or two constructive debates along the way.
	Of course I accept that there are questions of what message of prevention should be given. I was in receipt of much advice on this point. Our message was concerned with being faithful to one partner and the use of condoms. In Uganda they added abstinence to this message—abstinence, being faithful and condom use. Some preach abstinence only.
	I am strongly in favour of trying to persuade children scarcely into their teens to postpone their first sexual encounter but I rather doubt the impact of that message further up the age scale. It has not worked in the past—it was certainly tried and failed in the First World War to counter venereal disease—and I remain convinced that promotion of the use of condoms must be a central message.
	I deplore the entirely false statements of some—including, I regret, one or two senior figures in the Roman Catholic Church—that cast doubt upon the safety of condoms.
	I have concentrated on prevention, for that is crucial if we are to check the spread of HIV. But treatment is of course the other essential part of any global policy. There is no point in advocating more testing for HIV if there is no treatment to follow it up. People will ask what is the point.
	Here we come to the question of increased resources. We have much of the mechanism to deploy such resources in place, like the excellent Global Fund, which I visited a few months ago in Geneva. What we so clearly need is a greater commitment from the West—from the high-income countries—to this fight.
	And here, perhaps against the trend, I praise the United States. When I went to the United States when President Reagan was in power HIV was scarcely on the national agenda. There was an atmosphere of embarrassment about the whole position. Earlier this year when I returned, I found a President committed to spending overseas 15 billion dollars over the next five years and a new co-ordinating office based at the State Department to bring together that effort.
	Indeed, I would say that we in Europe spend rather too much time asking what more the United States can do and too little time asking what more Europe can do. We spend too little time examining our own priorities—priorities that meant that last year the European Union spent £32.5 billion on the common agricultural policy while millions die unnecessarily in countries which do not share our standard of living. Just think what more we could achieve with just one tenth of that budget.
	I believe we should follow the American example and have a European co-ordinator for HIV/AIDS who would not only bring the European effort together but also work to raise the resources so that at least we matched the American effort.
	I see now that the Government here intend to re-develop their policy and take the lead in Europe. I certainly welcome that intention. But if the Government are to do that, then it must be more than another declaration of intent—another initiative which grabs the headlines today but is forgotten tomorrow. It must be action that makes a real difference.
	And I also say this to the Government. They must have the authority to lead. They cannot lecture others abroad while doing all too little themselves at home. Their record on HIV/AIDS at home is not remotely impressive. Their record on sexual disease generally is lamentable.
	The number of attendances at sexual disease clinics has more than doubled since the early 1990s to over 1.2 million a year. Since 1996 chlamydia is up by 140 per cent, gonorrhoea by 106 per cent and syphilis by 910 per cent.
	Everyone in the field—apart from the Government— talks of a crisis, and a crisis there is. So yes, let the Government make a new effort abroad—and I support that entirely—but let them also show at home the kind of leadership that they urge governments overseas to take.
	On the face of it, there is all too little for our comfort around the world. But there are also opportunities. There are countries like India which stand at a crossroads. We can reduce the harm and the deaths. We can provide hope. We can check some of the destruction that HIV/AIDS will otherwise cause. We will need determination and we will need resources. But history will not forgive us if we fail to take the action which is open to us. I beg to move for Papers.

The Lord Bishop of Salisbury: My Lords, last week I visited the offices of Hope and Homes for Children, a charity based in Salisbury, which is a testament to the brave vision of its founders Mark and Caroline Cook. It works in 14 different countries across the world and, in the words of its mission statement it seeks,
	"To give hope to children who have nowhere to live".
	Its most recent fundraising video is subtitled,
	"When the cameras move on, we stay".
	It is a slogan that speaks to the changing and changeable nature of public concern, easily drawn to new and vivid calamity and perpetually on the move.
	It is against that background that I congratulate the noble Lord, Lord Fowler, on securing this debate. The cameras do so often move on; many subjects clamour for public concern; yet the worldwide spread of HIV/AIDS demands our urgent and constant attention.
	As the Archbishop of Cape Town has said:
	"No one should care alone. No one should die alone. For we are all living with AIDS".
	The diocese of Salisbury is linked to the Episcopal Church in Sudan. The House will know that war has disfigured Sudan for more than 30 years, leaving the south of the country bereft of any organised economic activity or civic administration.
	Ironically the near impossibility of travel and the isolation of many communities mean that the AIDS pandemic has had little impact yet. Because the bridges are down and most roads are impassable to lorries and trucks, that particular source of infection has been halted in its tracks. It is a war that has cut a swathe through Sudanese life and torn apart the fabric of society. But, none the less, in that society there is one small glimmer of hope. People are not able to move as easily in that southern part of the country as they would in other parts of sub-Saharan Africa. That has curiously given us an advantage.
	The consequences of HIV/AIDS for other African communities are no less devastating than these decades of brutal war have been for Sudan. Individuals suffer, and their families with them, but the spread of infection is so great that the precious threads that bind societies together are stretched to breaking point and beyond. When breadwinners die, when parents die, when carers die, the impact is felt far beyond the walls of the family home. Each death is a blow to the commonweal—the whole human family—a fresh assault on the possibility of people living peacefully and creatively together, because AIDS erodes trust and breeds fear. As one 15 year-old says:
	"Although my friends support me and I can talk to my grandparents I feel very sorry for myself. I have lost all the happiness in life and I won't be able to achieve my ambition to be a nurse. I don't want to get married because I'm afraid of getting HIV".
	Last week was Christian Aid Week and all over the country volunteers have taken part in the largest house-to-house collection of its kind in the annual programme. They have done so because of their commitment to Christian Aid's determined slogan, "We believe in life before death". It is because of that belief and that commitment to life, and to life lived together purposefully and creatively, that the Anglican Communion has pledged itself to,
	"the promise that future generations will be born and live in a world free from AIDS",
	as the Primates of our Communion declared over two years ago.
	It is not a wholly unrealistic aspiration. When the Secretary of State for International Development addressed the General Synod of the Church of England in February, he said:
	"This is not a hopeless battle. We have the means to defeat HIV/AIDS".
	As a result of the Secretary of State's address to the Synod and the motion passed there, the Mission and Public Affairs Council has published a report telling the story, being positive about HIV/AIDS. Perhaps I may read the House two paragraphs from it, the story of a young man. It is as follows:
	"Vitalis . . . is 29 and lives in Njombe in Tanzania. He is HIV-positive but doesn't know how he became infected. He thinks it may have been when he and his elder sister (who is also positive) visited a traditional healer. The doctor's 'cure' for his sister involved cutting both their hands with the same instrument he had used on other patients . . .
	"Although Vitalis has a girlfriend he hasn't told her his status; he has simply said that he has decided he doesn't want children just yet so they must use a condom. He is trained in building construction and still works when he is well and there is work available, but that is not enough to support him".
	It is stories such as those that indicate the extraordinarily porous boundaries of the disease and the way in which the slightest accident or negligence can easily infect someone. A nurse from Salisbury who went out to work in a hospital in sub-Saharan Africa caught the infection, probably from a discarded needle on a surgery floor, and died a long and painful death in Salisbury some years ago now.
	But this battle, as battle it is, needs resources. Her Majesty's Government have given generously to HIV work and are, I believe, the second largest donor in the world. It has been estimated that, by 2007, 15 billion dollars per year will be needed to secure a minimal global level of prevention, care and treatment. I believe that our Government must continue to show leadership by doing what many donors to Christian Aid will have done this last week, and giving again, giving recklessly and giving more than their share.
	For their part, the Churches and their partners will continue their work of caring for those most directly affected by AIDS and fighting against the stigma that still shamefully attaches to it. But if these greater resources are to be found and the promises to be realised, then—at the risk of sounding a familiar note—above all else it needs attention, attention, attention. It cannot be allowed to slip from the public agenda and the Churches will do their best to ensure that it does not.
	We are told that we are engaged in fighting a war against terrorism. We need also to be engaged in fighting a war against poverty and disease. Were we all to be convinced of that then slender budgets would cease to be a constraint.
	What can we do? First, HIV is about people in relationships. The sick need to be cared for in their own homes and orphaned children need care in their own communities. Prevention is best done through the informal networks of community, peer group and family. That is why the Churches, which in Africa are frequently the most vibrant and far-reaching community networks, are so well placed to help. And the community focus is key if people with HIV/AIDS are not to be stigmatised and therefore shunned. When people are afraid to talk, afraid to declare what they fear may be happening to them, the hidden fears eat away at the bonds of community. Who trusts who? Who will support who? Support for the carers and treatment for the sufferers will not be forthcoming unless there can be an international climate of concern and openness which brings HIV/AIDS to the top of governmental agendas in sub-Saharan Africa.
	The people of Sudan hope that peace will soon be theirs. Peace will mean the building of roads and the rebuilding of bridges and the advent of the huge trucks, the harbingers perhaps of economic reconstruction and inward investment. How tragic if that new communication brings with it the deadly threat of HIV/AIDS. As Mark and Caroline Cook know, the children of Africa deserve homes and families. Above all, they deserve hope and a future.

Lord Colwyn: My Lords, my noble friend Lord Fowler initiated a similar debate on 20 February 2003 and was congratulated on his commitment as Secretary of State when the AIDS epidemic first appeared and on his continued interest in the current situation. I should like to offer similar congratulations today, but warn him that my views do not and have not always conformed to popular opinion. I think that it is unlikely that any of your Lordships will agree with any of what I have to say.
	I have always been concerned that there are many scientific facts that can show that the human immunodeficiency virus does not fulfil the epidemiological and biological requirements, nor the common sense requirements, to be the cause of the human immunodeficiency syndrome. We do not understand AIDS. Virtually all of the scientific community has taken a germ-theory view that HIV is capable of causing a syndrome of ever-advancing immune suppression that will eventually cause death.
	The lack of understanding means insufficient knowledge to be able to intervene in or control the disease process. Epidemiologists must be able to predict accurately when outbreaks will occur and who is at highest risk. Microbiologists must be able to prove the underlying causes of the disease. Immunologists must be able to explain how the immune system fails and what may be done to protect it. Anthropologists and sociologists must be able to identify behavioural patterns and cultural environments that put people at risk. And public health officials and physicians must be able to implement effective preventative measures and cures. By these criteria, we do not understand AIDS.
	It is imperative to rethink and research AIDS. There are a few lone heretics such as the University of California professor of molecular biology, Peter Duesberg, and Australian biophysicist Eleni Papadopulos Eleopulos, who have offered exhaustively referenced argument that HIV infection does not lead to AIDS and that the test is so inaccurate that it should not be used. Both have been vilified for their troubles, but even if they are only pointing to an alternative pathway, the implications are of great concern.
	By rallying round the HIV theory we may be erroneously lumping together under the umbrella term AIDS some 25 disparate, previously identified diseases acquired by a number of non-contagious means. With the inaccuracy of the tests, this means that we could be misdiagnosing as HIV-positive many thousands of basically healthy people and subjecting them to highly toxic, potentially lethal drugs, the side effects of which are now indistinguishable from what we consider AIDS-related illness. Certainly that was true of AZT, which was originally marketed as an anti-cancer chemotherapeutic agent and found to be too toxic for use.
	Having HIV does not mean having AIDS. My noble friend Lord Fowler and the right reverend Prelate referred to HIV/AIDS as a single entity. The presence of human immunodeficiency virus is not proven beyond doubt to be the sole cause of AIDS, nor does the presence of HIV lead inevitably to AIDS.
	The HIV virus is not a particularly aggressive or fast-replicating virus. It affects different people in different ways, which is why some people can contract the virus and die rapidly and others are alive and healthy 15 to 20 years later. Investigators who defend HIV as the cause of the syndrome have proposed a vast variety of agents as helpers or cofactors of HIV in the genesis of AIDS. However, those cofactors are in themselves causal agents of immunodeficiency and may generate AIDS with or without the diagnosis of HIV. Dr Roberto Giraldo calls such cofactors "immunological stressor agents".
	The real circumstances that surround all the groups of people who develop AIDS with the greatest frequency is the exaggerated exposure to a variety of stressor agents against the immune system that can have a chemical, physical, biological, mental or nutritional origin. AIDS has appeared at a time when the immune system of human beings is saturated and is deteriorating due to exposure, both involuntary and voluntary, to immunological stresses. The capabilities and functions of the immune system are neither infallible nor infinite.
	The incremental stressors in our ecosystem are endangering the preservation of our species. AIDS is an alarm call. The distribution of those stressors varies within groups of people who develop the syndrome and explains the different clinical forms of AIDS that occur in different people. Progressive and continuous deterioration of the immune system causes a deficit of the defence, surveillance and homeostasis immunological functions with the subsequent development of infections, neoplasias and metabolic alterations.
	Although I am not an expert, I am concerned that drug treatments for AIDS, the protease inhibitors and other antiretrovirals can add to the total of immune system stressors. That toxic hypothesis of AIDS provides a rational explanation that the infectious hypothesis has not solved, not to mention the millions of pounds invested in research, prevention and patient care within the infectious concept of the syndrome. The AIDS test is neither sensible nor specific for detecting past or present infection with HIV.
	The medical and research communities are the greatest asset in the fight against AIDS and potentially also the greatest threat to its success. There can be no breakthroughs without research, but breakthrough research is not possible when conformity is rewarded and sceptical inquiry punished. AIDS may continue to plague modern society, just as other preventable infections plagued our forebears, because of the closed-mindedness of the very physicians whose job it is to diagnose, treat and prevent those diseases.
	A century ago, they let patients die by denying that germs had anything to do with disease. Today they may be letting them die by insisting that the germ is everything. Without doubt the virus is detrimental to the immune system and speeds up the process of disease, but it is not solely responsible for the ill health associated with AIDS.
	More relevant is long-term abuse of the body through poor nutrition, environmental toxins in the air and food chain, the chemicals produced by stress, drugs and frequent exposure to infections and the antibiotics with which they are treated. A happy medium must exist somewhere in between, but it will be reached only when informed scepticism and razor-sharp reasoning skills become as valuable assets to scientists and physicians as are advanced degrees, an infallible memory or respect for authority.

The Earl of Sandwich: My Lords, I thank the noble Lord, Lord Fowler, for his energetic pursuit of the subject, which we all know to be one of the most urgent in the world, even though, as we have just heard, we may not altogether understand it.
	I welcome the new government strategy set out in the consultation document and I salute DfID's leadership alongside UNAIDS. I join the debate as one who advocates a greater role for civil society in the AIDS campaign. That was a key point in the declaration of commitment adopted by the UN in June 2001, which called for the active participation of civil society, the private sector and faith-based organisations.
	I have seen for myself the effectiveness of those organisations in tackling HIV/AIDS, especially in Uganda where a few years ago I visited projects supported by Christian Aid, of which I am a trustee, and by UWESO, the Ugandan charity for orphans, which I greatly admire and support.
	I am glad to see the noble Lord, Lord McColl, in his place, because we were both present at the opening of the Mildmay Centre—a new international hostel for AIDS patients near Kampala—and at the AIDS conference opened by President Museveni. The poverty focus of the DfID approach is welcome, not least because of the millennium development goals, of which AIDS is an important part. They could easily be in jeopardy since such a pandemic cruelly eats into every aspect of development.
	But there are risks that earmarked support or a short-term emergency response will bypass normal health services and create a parallel culture, as has happened with some vertical UN programmes in the past. It is a paradox of aid that sudden epidemics or new sources of funding produce new vehicles, clinics and personnel that may demonstrate visible action but do not necessarily serve the poorest communities.
	Connected with that is the problem of centralised budgets. Will the Minister confirm that DfID policy within the poverty reduction strategy process is to provide direct budgetary support for health services? How will that policy conflict with the need to target AIDS programmes in the voluntary sector without going through national budgets? I know that many NGOs here are concerned about that issue and how even the "Three by Five" initiative and the "Three Ones" programme may work against them.
	One way round the problem is for DfID to identify and directly support civil society organisations that are part of a network and known to be in close harmony with existing HIV/AIDS and other health services. That is particularly true in countries such as Uganda and Senegal where there is an active network. It is much more difficult in countries or regions where, perhaps because of internal conflict, there is much less national co-ordination.
	Section three on page 12 of the strategy highlights effective national responses and endorses the need for a pluralist approach, which is important. On the one hand, it is essential to strengthen and improve access to general health services, because acute needs arising from poverty, ill health and other causes of child mortality are linked with vulnerability to HIV/AIDS. At the same time, responses to HIV/AIDS prevention must be highly targeted and inevitably selective, because of the differences of approach and capacity in different communities.
	The consultation paper therefore says that a multi-sectoral approach is required, but I wonder whether the strategy places enough emphasis on the current effectiveness of civil society partners and the need to involve them more in decision making. One area of AIDS prevention where civil society may be paramount is in health education. Of course the use of radio and public advertising is helpful, but as the right reverend Prelate said it is through word of mouth through the churches, mosques and village-level organisations that the message is best channelled.
	I have attended, as I am sure have many noble Lords, an evangelical church service that devoted large parts of the liturgy to teaching and story-telling about the risks of AIDS. In villages I have attended singing and drama sessions involving all sections of the community, ensuring that information is shared among young and old and that the basic needs of patients and families are being met.
	Civil society, in the official language of development, is now a key partner in poverty reduction strategies. That sounds good. But integrating NGOs into a national strategy is not easy and it obviously raises much deeper questions about accountability and political representation. Yet more advocacy by prominent civil society groups could be especially crucial in bringing HIV up the political agenda in those newly affected countries—some of which the noble Lord, Lord Fowler, mentioned—at an early stage of an epidemic where the impact of HIV is not yet apparent. DfID should, and perhaps does, prioritise support for such work, which could bring about the high-level political commitment which we have seen to be so effective in Uganda.
	Another area where such an approach is important is in the reduction of stigma. Christian Aid in its submission to DfID's consultation offers the example of a group of four NGOs in Karnataka, south India, known as the MILAN coalition. They are also supported by the Elton John Foundation.
	According to this group, stigma is fuelled by six factors: ignorance of HIV/AIDS, fear, taboos concerning sex, too little sex education for young people, lack of sensitisation in the medical profession, and lack of anti-retroviral therapy. The project aims to address some of these factors through information provision and discussion at community level. The MILAN group identifies sex workers as particularly stigmatised and vulnerable—and in its first phase the project is focusing attention on them.
	Then there is advocacy. Besides pooling their knowledge of training and counselling, the four organisations select what they call, "positive speakers"—we know of similar examples in South Africa—who can openly talk about their status in public as part of prevention as well as for the media. This is a very powerful means of reducing stigma and motivating people to undergo testing. It is difficult to find enough people willing to be so open about themselves, but combining four organisations is more likely to result in the critical mass needed for effective impact on the public.
	The consultation paper says comparatively little about ARV, perhaps because research is moving so fast, but I hope that the Minister when he covers the question of ARV treatment will explain why that is so.
	I have one further question for the Minister in respect of tuberculosis. One in three people worldwide living with HIV is co-infected with TB, and nine out of 10 die of TB within a few months of contracting HIV unless treatment is available for TB. But HIV causes TB to spread so fast that the health service cannot possibly catch up, even though it is expanding. What is DfID doing to help UNAIDS and WHO to combine AIDS and TB services as a matter of urgency? I am sure that the Minister recognises that AIDS programmes could learn much from the experience of other programmes of primary healthcare, for example, and reproductive health, including in the training of paramedics and local workers—programmes which already use this integrated approach could be applied to HIV/AIDS.

Lord Brooke of Sutton Mandeville: My Lords, it is a privilege to follow the deeply impressive speech of the noble Earl, Lord Sandwich—he often makes such speeches in international debates in your Lordships' House—just as it is a rich pleasure to join others in your Lordships' House in congratulating my noble friend Lord Fowler on having secured this debate and on the comprehensively magisterial way in which he opened it.
	A quarter of an hour is a smidgen in which to lay out a global problem: imagine what Mr Gladstone would have made of it. As the poet once said, the Ancient of Days is an hour or two old. My noble friend moreover played a distinguished part in orchestrating Her Majesty's Government's response to the AIDS challenge in this country two decades ago. No one can read the mind of another but it would not surprise me if my noble friend felt within himself that it was the finest thing he did in more than a decade at Cabinet level, and he has enhanced that record by the way that he has kept the faith of this issue in the near decade and a half since he left office.
	As a parishioner in the diocese of Salisbury I express pride and pleasure that our eponymous bishop should have taken part in this debate. I admire the courageous heterodoxy of my noble friend Lord Colwyn—heterodoxy which is the touchstone of your Lordships' House—though I shall not follow him precisely in the line that he took. My own qualifications for speaking are much more modest but I passionately hope that the moment has come when global society has begun fully to gird its loins—if I may be allowed to use the phrase—to cope with this challenge, as my noble friend did 20 years ago.
	Colin Powell said last month that HIV/AIDS is the greatest threat to mankind today—the greatest weapon of mass destruction on the Earth. It has been likened to the Black Death. I had never thought of the consequentials of that before today, but our hearts must go out down the centuries to the despair of those of our ancestors in the same positions of influence as ourselves then wrestling with that challenge armed with the knowledge and the instruments of 14th century experience. That comparison alone should put us on our mettle.
	We come together, too, in this particular capital at an appropriate crux of timing. Last month the Economist published a thorough and well informed special report on AIDS in India. Yesterday, inspired perhaps by the Government's commission on Africa—and parenthetically Parliament's renewed interest in the Dark Continent is a profoundly encouraging development—the All-Party Parliamentary Group on Africa was due to publish its report on AIDS in Africa, developed after evidential hearings. That is now delayed until after the Recess, but the final coda in the draft version runs to nearly 150 footnotes, which itself is a potential index of thoroughness. Its original publication date prompted the colloquium which is due to take place at Marlborough House tomorrow— a location that underlies the salient role this country can relevantly play on the international stage in this regard.
	Then we have, too, the Government's draft consultation document on the new strategy of HIV/AIDS in the developing world, to which a couple of references have been made. At the vortex of this pouring out of printers' ink, after 20 years in which disaster has been tempered by comparative and often unpredicted recovery in different continents—I add to my noble friend's listing of Thailand and Uganda, Brazil, which is in yet another continent still—one is driven back ineluctably to the ancient human truth that, if a human group is to change its behaviour, the critical essential is that the leader of the group has with genuine resolution to want that to happen.
	To illustrate that in the unfolding story—I go away from Brazil, Thailand and Uganda—the leadership example of Chandrababu Naidu, the Chief Minister of Andhra Pradesh, where the HIV prevalence rate is over 1 per cent of the population, is a classic instance. April's Economist report is eloquent on what that commitment has involved. If his insistence that all his Ministers should include a reference to AIDS in every speech they make, whatever the topic, challenged their speech writers, it was a nobler cause than that similar instance in Belfast in the late 1980s when an editor insisted that every musical criticism in his paper should contain a disparaging reference to the Anglo-Irish Agreement.
	In this context the prose of the Government's draft consultation document, perhaps inevitably, has, at least to my ear, all the charm of a "speak your weight" machine. I do not necessarily regard that as a disparagement for it may be responsive to the nature of the subject, though I suspect that Mr Gladstone would have been more Homeric or perhaps Aeschylean. What matters is that the policy strategy should optimise the deployment of our own resources. It is one of those cases where the Prime Minister's rhetoric could more usefully follow the plan than precede it. Most important of all will be the role of Mr Hilary Benn, whose pedigree as a communicator is matched by a most engaging matter of fact modesty. What matters is that he should recognise and then make clear the centrality of this issue in this decade to his department's raison d'être. I am obviously referring to DfID.
	There is one sentence in the draft document which is an encouraging harbinger of this possibility, and I quote:
	"The UK response at global level in providing support to these key agencies (e.g. UNHCR, WHO through its Health Action in Crises, UNICEF, UNDP and others) to enable them to tackle HIV in difficult environments is essential".
	That remark has a flavour of our centrality. As an American historian once wrote,
	"Lincoln wanted to have God on his side, but he had to have Kentucky".
	In peacekeeping the UN has a perennial specification that British troops should if possible always be involved. HIV/AIDS may confer on us the same necessary ubiquity.
	If local leadership is critical, and British leadership a potential catalyst, how do we play our role where denial is in operation and neo-imperialism classically counter-productive, and there seems to be a job for all of us?
	The last time that I was in Pretoria, I had a long conversation at a High Commission party with an Afrikaner girl, who said she found HIV/AIDS hard to grapple with because she had, within her social milieu, absolutely no experience of it at all. The places where denial rules are, I suppose, the equivalent of the despair that policy makers felt towards the Black Death six and a half centuries ago. Wiser men than I will know how one should respond. At my simplistic level I feel relief that there is so much else to do on a worldwide scale that one can concentrate on the feasible, even if one reluctantly put the temporarily intractable on the back burner.
	I want to deal with Africa before I conclude, but, first, to say an ominous word about India—to which my noble friend Lord Fowler referred. When I was at school, my school number was 666, which the Bishops' Bench will recognise as the number of the beast in the Book of Revelation. In the Economist report on India I could not help noticing the awful symmetry that 4.58 million are infected with HIV—and my noble friend qualified that figure upwards—and that almost 450,000 Indians die of tuberculosis each year. There, I echo the noble Earl, Lord Sandwich. That figure is most commonly among HIV positive people, but 4.56 million dollars will be spent each year for the next three years by Star television on airtime for public service advertisements about AIDS.
	Like my noble friend Lord Fowler I was at the beginning of the Government's response here, for it was the Medical Research Council which persuaded the late, great Sir Keith Joseph that a database of incidence was crucial to an effective strategy and I would be interested to hear in the Minister's reply how far our experience of that early step in the process is transmitted to countries such as India, if they genuinely want to learn, and whether it is part of the practical help that we offer.
	In what is still the draft African report from the All-Party Group, what runs through chapter after chapter, haunting and spectral, yet golden in its examples of heroism, are the orphans. They are their countries' future, but they are also a cause to which all mankind can reach out. In the mean time, as Dr Alex de Waal said memorably at the Africa All-Party Group meeting that sparked off the report, Africa is in some ways like a university where the student union leaders have disproportionate authority because many of the dons who would have lent them balance and guidance are dead.
	Finally, for those who ask us what difference the man on the Clapham omnibus can make, I report what your Lordships' House will already know—that the charity whose title is the entrancing injunction Send a Cow are now sending whole farmyards of different farm animals to east Africa in general and fruit trees to Ethiopia in particular. In the world's long history, this is not the occasion where, for individuals, passing by on the other side of the road is an option.

Baroness Stern: My Lords, I would like to echo the remarks made by the noble Lord, Lord Brooke, about the noble Lord, Lord Fowler, and thank him for initiating this important debate.
	The United Kingdom response in the mid-1980s to the HIV/AIDS problem is seen as a model in international circles. The noble Lord, Lord Fowler, was in the driving seat at that time and must take the credit for the enlightened and far-sighted approach that was taken. I remember receiving the leaflet he sent me and the rest of the population and thinking, "This is an unusually sensible document to come from the Government".
	I wish to limit my contribution to one aspect only of this problem, but I hope to show a very central aspect—the prevalence, transmission and prevention of HIV in the prison systems of the world. In that context I declare an interest as a board member of Penal Reform International. Rates of HIV infection are very high in prisons in many parts of the world. Prisons have always been places where sickness is concentrated and from where epidemics have spread; and the HIV epidemic is no different.
	According to the World Health Organisation, one can multiply the official HIV statistics of a country at a given moment by a factor of between five and 10 to get an actual estimate of the rate of infection in a country's prisons. HIV in prisons is particularly acute in eastern Europe and central Asia, where the rates of HIV infection are now increasing rapidly. In some of the new European Union states, HIV infections are also on a rapid rise in prisons. In Estonia, the first HIV-infected prisoner was diagnosed in 2000. Since then the number has increased by four or five every week. In Latvia, the number of HIV-positive prisoners increased by 58 per cent between 2000 and 2001.
	There was a well publicised case of an increase at one prison in Lithuania. In 2002, 229 infected prisoners were being held there. Between May and July of that year 44 more infections were added because, it is said, they all used the same needles to inject drugs. Recorded cases of infections in prisons in Russia have risen from seven in 1995 to 30,000 in 2003. I strongly endorse the point made by my noble friend Lord Sandwich regarding the co-morbidity with TB. In some of the countries that I have mentioned, active TB affects 10 per cent of all prisoners.
	The reasons for those high infection rates will be obvious to noble Lords. One reason is the nature of the population that prisons receive. People in prison come from the most disadvantaged sections of any society. They come to prison with ill health, with many untreated conditions and they engage in risky behaviour such as drug taking. Prisons are full of people who use illegal drugs. In Russia and Ukraine more than 90 per cent of HIV-infected prisoners are intravenous drug users. Secondly, the environment itself in prison is disease-producing, because of unprotected sex—consensual and forced—tattooing with unclean needles and injecting drugs with shared needles. It is not just those who enter prison as drug users who engage in that behaviour. Research shows that in west European prisons the percentage of prisoners who first start to inject drugs while in prison ranges from 7 per cent in some countries to 24 per cent in others. Research also shows that a quarter of Russian prisoners were tattooed in prison—two thirds with needles already used on someone else.
	This is a crisis for many prisons and, as the noble Lord, Lord Fowler, said, we know exactly what to do about it. Therefore, it is vital that prisons are included in all national HIV prevention policies. It is also vital that harm reduction measures are accepted and that public health priorities are clearly asserted. But this is a real challenge that causes dilemmas and grave difficulties in prison systems all over the world.
	Prisons need to take action to stop the spread of HIV. They need to stop prisoners taking such risks as unprotected sex or injecting with the same needle. However, we will all be aware of how easy it is to say that and how difficult it is to implement. To do those things, prison officials have to accept some harsh realities that they would often rather deny. However good their security measures are, however many sniffer dogs and body searches take place, drugs get into prison. In some countries with poorly paid prison guards corruption ensures a regular supply. Sex takes place in prisons the world over, so condoms should be available to prisoners easily and without embarrassment. I will not recite the long saga of getting prisoners access to condoms in the Prison Service of England and Wales. I understand that prisoners now have access, but that the method of giving them access is likely to be a deterrent to many.
	Substitution, maybe a methadone maintenance programme, needs to be available so that those who inject drugs may move to a safer method. The provision of bleach and other disinfectants in prisons is basic and absolutely essential, so that shared needles may be cleaned.
	Finally, there is the provision of needle exchange facilities. The Government are greatly to be congratulated on the move they took to bring prison health services in England and Wales into the Department of Health, and under the National Health Service. I know this has meant significant progress in taking forward measures that should have been in place since those early days when the noble Lord, Lord Fowler, was at the Department of Health.
	I would like the Minister to reassure me that the rollout of the programme to provide disinfectants will continue energetically, the provision of condoms will be improved, and the possibility of needle exchange programmes, where the need can be proven, will at the very least be kept on the agenda. I would also like the Government to ensure that the question of HIV in prisons is part of their international development and human rights agendas.
	Those noble Lords who visit prisons abroad may well have seen the compulsory testing of prisoners that leads to a diagnosis but no treatment. This results in the segregation of HIV-positive prisoners in the worst and darkest accommodation, where prison staff do not go, and medical staff give treatment through a grille in the cell door without touching the prisoner. Compulsory testing and segregation of HIV-infected prisoners are condemned both by the WHO and the Council of Europe. It is heartening to see that many countries new to this problem are taking action to improve their treatment of such prisoners. Kazakhstan has taken the lead in central Asia by eliminating compulsory testing and segregation. Noble Lords may be interested to hear that the noble Baroness, Lady Massey of Darwen, who cannot be here today, has played a key role in educating medical workers in Kazakhstan about HIV prevention and treatment. Kyrgystan has initiated needle exchange programmes in its prisons, as has Moldova. There is much to do, and much good work to encourage.
	I draw the attention of the House to the Moscow declaration of the World Health Organisation in Europe, entitled Prison Health as Part of Public Health, which calls for prison and public health services to work together,
	"to ensure that harm reduction becomes the guiding principle on the prevention of HIV/AIDS"
	in prison systems.
	Will the Minister ensure that this declaration will be wholeheartedly supported by the UK representatives at the next annual meeting of WHO Europe?
	Finally, will the Minister ensure that all HIV prevention projects funded by his colleagues in the DfID include the prison system and prisoners in their scope, because hundreds of thousands of prisoners leave prison every year taking their infections with them?

Baroness Masham of Ilton: My Lords, I thank my noble friend Lady Stern for what she said about prisons. I agree with all of it.
	I congratulate the noble Lord, Lord Fowler, on his choice of debate, because the increasing spread of HIV/AIDS needs addressing. It is devastating communities and mutilating families, especially in some African countries. I thank the noble Lord, who understands the many problems relating to HIV/AIDS. He was Secretary of State for Health at the start of the AIDS catastrophe, and I am sure the campaign warning people of the dangers of HIV/AIDS had an effect on prevention.
	I am also sure, with the current increase of HIV and other sexually transmitted diseases, that there should be continued campaigns on prevention. We have a very dangerous situation at the moment, where many young women and men just do not care and have unprotected sex with many different partners. As sexually transmitted infections facilitate the transmission of HIV, it is possible that the rise in these may have played a significant part in the increase in HIV among gay men. All sexually transmitted infections have increased in England, Wales and Northern Ireland. That is why I asked the Government a few months ago whether there should be a national service framework—for this growing problem.
	Something has to be done. People across the world did not take the advice that one partner was the safest option. The recent case of the man from Middlesbrough who had come from Africa and knowingly infected three women, and has now been given a 10-year prison sentence, might make a few people think. Should there not be clear legal guidelines, stating that it is a criminal offence to knowingly infect people with the HIV virus?
	There is concern that the removal of dedicated funding for treatment and prevention of HIV/AIDS in recent years will place the investment in services over the past 20 years at risk. There should be a commitment to ongoing funding, not one-offs, to ensure the availability of appropriate treatment and care for those eligible.
	Many people and organisations from Britain are helping and giving support to developing countries, and that is good. But we must not neglect our own people, living in our own communities. HIV/AIDS is a horrible condition. It complicates lives. The difficulties over confidentiality can make communication difficult. There are many problems which can arise for people whose health deteriorates, such as housing needs, social care, arranging meals, visits to hospitals, and companionship if people live alone.
	A very unfortunate situation has arisen at the Mildmay Hospital in Hackney. This is a dedicated hospital for people with HIV/AIDS, giving respite, rehabilitation and hospice care. It founded a family centre for children and parents living with HIV/AIDS who needed support. The children had good play facilities and lunch, while the mothers had rest and treatment. The family care centre ceased to operate in 2002. Health authorities are no longer prepared to fund family admissions, arguing that this is not something they do with other illnesses. Health authorities withdrew funding for children infected or affected by HIV, on the basis that this is not a health issue. The Mildmay is concerned about the withdrawal of HIV-specific funding. It is being increasingly financially squeezed, as PCTs no longer give HIV priority.
	As the Mildmay Mission Hospital does missionary work, it has two thriving AIDS centres in Africa: one in Uganda and one in Zimbabwe. Should we not be looking after our own people at home, as well as helping others? When I think of the smiling little faces of these children enjoying their play facilities and lunch, it makes me sad to think that some of them will now be isolated at home while their mothers lie resting, without the support that was so needed, which the Mildmay was able to give them.
	I hope the Minister will be able to tell the House what progress the Global Fund to fight AIDS, TB and malaria is achieving. This has been a priority for the UK and I wonder whether the Minister can say which countries have supported the Global Fund and which have not.
	Last year, a parliamentary delegation from the HIV/AIDS group from India visited us in Parliament. It was good to meet them and to hear that, like us, they had a parliamentary group. With more than 4.6 million HIV-infected people, India has the second-highest rate of HIV infection in the world after South Africa.
	HIV/AIDS is the biggest threat to global development and stability in our time—not only in Africa but also across the world. It is no longer simply a health issue; it is a human rights issue that cuts across all aspects of social, political and economic life.
	Children orphaned and made vulnerable by HIV/AIDS experience a wide array of problems. In addition to the psycho-social distress of losing one or both parents, they may also lack food, shelter, clothing or healthcare. They may be forced to drop out of school or required to care for chronically ill adults or younger siblings. They may face discrimination, abuse or exploitation. Deprived of parental guidance and protection, they may themselves become vulnerable to HIV infection.
	HIV is causing so many problems, it is encouraging when one hears that governments have accepted there is a problem with HIV in their country. Governments from all over the world must do all they can to prevent the spread of this deadly infection.

Lord Chan: My Lords, I, too, thank the noble Lord, Lord Fowler, for giving us this opportunity to focus on HIV/AIDS, which is typically a sexually transmitted disease. It disproportionately affects the poorest people, with devastating results, in developing countries. I intend to focus on the integration of existing health services to help in particular children in developing countries—the 700,000 who were infected last year resulting in 500,000 deaths.
	Globally, as the noble Lord, Lord Fowler, told us, between 40 million and 46 million individuals live with HIV, 95 per cent of them in developing countries. Africa is now the most affected continent, with 30 million in sub-Saharan countries where six in 10 sufferers are women.
	Twenty-nine million people have died of AIDS so far, with 3 million dying last year. As most of the deaths occur in young adults, some 14 million children have lost at least one parent to HIV/AIDS. It is estimated that by 2010, 20 million children will have lost a parent from AIDS. That orphaning in highly affected countries may cause children to enter the labour market before they have completed school education and exacerbate problems of child labour. Financial help needs to be given to families where one or both parents have died of HIV/AIDS.
	The low status of girls and women in many traditional societies in Africa and especially in Asia, has led to them being sold into prostitution, which in turn spreads HIV/AIDS faster and further in those countries. In India, where young women join the sex industry in metropolitan cities from poor rural communities, including from Nepal, HIV spreads to their home when they return with the disease. India now has between 4.58 million to 6 million living with HIV, a number that is second only to South Africa, as most of us are aware.
	However, when I was working in India in the late 1980s and early 1990s, there was a denial that HIV and certainly AIDS were important. It was said that only a few thousand people were infected. Well, the figure has now grown to millions. Therefore, if all girls were educated in schools, they would be economically active without being exploited in the sex industry. Is that something in which we can encourage the international community to invest?
	Some services which reduce the risk of HIV infection exist, but they are mainly for reproductive health and are not integrated with initiatives in HIV/AIDS. Because poor developing countries cannot afford to establish a separate service for sexually transmitted infections, particularly because of the stigma, integration of reproductive health services with HIV would seem to be logical and economically sound. Services such as maternal and child health clinics that incorporate family planning information and supplies of condoms could also identify mothers with HIV and provide them and their babies with anti-retroviral drugs to prevent the new-born babies from becoming infected. Improving reproductive health services is essential to combating HIV/AIDS through HIV counselling, increased condom availability for use by men and also condoms for women through the management of sexually transmitted infections.
	Teams that treat malaria in endemic areas are becoming another avenue of tackling HIV and associated infections such as tuberculosis. These teams give anti-malarial medicines after testing the patient's blood for malarial parasites. Blood can also be collected to screen for HIV and implement treatment. When providing advice on how to prevent children from being bitten by malaria-carrying mosquitoes, information on how to avoid sexually transmitted infections can also be given to the community. As chairman of a charity, the Malaria Consortium, I am encouraged by these positive developments to integrate the management of malaria and HIV in our African field areas in Uganda and in Ghana by local health teams. In addition, treatment for TB is given where required. We are monitoring the implementation of these programmes and collecting data.
	The All-Party Parliamentary Group on AIDS, of which I am a member, is particularly concerned about the rapidly emerging epidemics in eastern Europe and central Asia that have been identified by other noble Lords. The enormous growth of HIV in these countries cannot possibly be due only to better detection and is clearly a result of the rapid spread of HIV infection. This rapid infection rate will reduce economic growth by 1 per cent as spending on health in these countries on HIV/AIDS increases from 1 to 3 per cent of gross domestic product.
	When the HIV infection rate has increased beyond 1 per cent among adults, no country has been able to contain the epidemic. Russia is now approaching that 1 per cent threshold.
	The Chinese Government estimate that there are 840,000 HIV-positive people in their country and that 80,000 have AIDS. The UN estimates that there are at least 1 million people with HIV in China and that this number could grow to 20 million by 2010. That is probably a more realistic estimate than that of the Chinese Government because only 10 per cent of individuals in China know that they are infected with HIV.
	About 7.2 million people in Asia are HIV positive, with 5 million living in India and China. An estimated 500,000 people died of AIDS-related complications in Asia in 2002. The growing epidemic in Asia accounts for approximately 25 per cent of the world's new cases of HIV/AIDS.
	I know that the Department for International Development is consulting on its future programme for HIV/AIDS in developing countries. DfID has done, and continues to do, effective work to combat HIV/AIDS—something of which we can all be proud. Perhaps the Minister would consider international plans to control the spread of HIV/AIDS in Asia through education, capacity building and support for the treatment and prevention of this serious disease.
	In partnership with local mass media, information can be given to all communities about the dangers of HIV/AIDS and about how to avoid infection. In 2002, the BBC World Service assisted All India Radio and Doordarshan TV in disseminating information on HIV/AIDS. It was aimed at young people in northern India and information was given on how they could protect themselves and end discrimination against those living with AIDS. Is the Minister aware of any other partnerships along those lines in other parts of Asia?
	Finally, some developing countries in Africa and south-east Asia have begun to assess the effect of their local and national programmes for reducing the spread of HIV/AIDS. Uganda and Thailand, which have already been mentioned, have made progress in combating HIV/AIDS. Will Her Majesty's Government encourage and assist developing countries in learning good practice from other countries in their region or continent? Such learning would be more appropriate than using models that work in industrialised countries.

Lord St John of Bletso: My Lords, it is a pleasure to follow my noble friend Lord Chan with his distinguished international medical career. I join in thanking the noble Lord, Lord Fowler, for introducing this debate on the worldwide HIV/AIDS pandemic.
	We are all acutely conscious of the gravity of the situation in many parts of the world but, among the cacophony of statistics and projections, I was particularly moved by a recent report by Stephen Lewis, the United Nations Secretary-General's special envoy on HIV/AIDS in Africa. He was visiting a paediatric ward in Lusaka last year where doctors told him that, in that hospital alone, a child dies of HIV/ AIDS-related causes every 15 minutes. I fear that such situations are duplicated in many other hospitals, particularly in southern Africa. This is not about sterile statistics; this crisis is about human suffering on an almost unimaginable scale. Therefore, I thank the noble Lord, Lord Fowler, for once again bringing this issue to your Lordships' attention.
	Much is being done, and many new initiatives and projects are being launched month on month. The noble Baroness, Lady Jay, and the noble Lord, Lord Holme, will be co-chairing an important workshop on HIV/AIDS in southern Africa at Marlborough House tomorrow. As the noble Lord, Lord Fowler, mentioned in his powerful speech, this pandemic is a global problem. However, I should like to focus my remarks today on the serious situation in South Africa—a country in which I have spent most of my life.
	In South Africa, where the Minister of Health has long been extolling the medicinal qualities of olive oil, lemon, garlic and the African potato, the Government last November eventually—I stress, eventually—agreed to start the distribution of anti-retroviral drugs to patients with a CD count below 200. Almost 15,000 patients are now receiving this form of treatment, which will save some lives and certainly extend many others. This is a welcome start.
	I had lunch yesterday with the governor of the Reserve Bank of South Africa, Tito Mboweni, who confirmed that the South African Government have committed themselves to spending 12 billion rand on the struggle against HIV/AIDS over the next five years. This massively increased health budget, combined with the billions of dollars in aid from other countries—most notably, the United States and Britain—should maintain the delivery of anti-retroviral drugs nationwide.
	Incidentally, while this debate focuses on HIV/AIDS, we should be mindful that it is not the only killer disease in Africa. I was pleased that my noble friend Lord Chan mentioned the scourge of malaria. More than 350 million Africans—nearly half the population—contract malaria every year, and yet malaria medication is not proclaimed a basic human right. As my noble friend Lord Sandwich quoted, one in three people living with HIV worldwide are co-infected with tuberculosis, and nine out of 10 die of TB within a few months unless treatment is available. Spending on HIV/AIDS research currently exceeds spending on TB by a factor of 90 to one.
	Aside from caring for the suffering of HIV/AIDS patients, it is also important to focus funds on the whole issue of prevention. In this regard, it is encouraging to see the South African Government and private enterprise there combining to warn and inform the population. That prevailing resolve was reflected by Mbhazima Shilowa, the Premier of Gauteng, the former Transvaal, when he said last month:
	"Forty million South Africans are HIV-negative, and we want to keep them that way".
	The "Love Life" campaign has been spread across roadside billboards, candidly advocating safe sex and urging self-preservation. The Kaiser Foundation has put 500 million rand into a youth prevention campaign, and various British NGOs are making an invaluable contribution to this cause. Recent findings of the Reproductive Health Research Unit at the University of the Witwatersrand suggest that such measures are starting to produce positive results. The survey of 12,000 young people aged between 15 and 25 found that 32 per cent regularly use condoms—up from 8 per cent in 1998. It also suggests that the infection rate among 15 to 19 year-olds is slowing.
	There are positive indicators in what otherwise remains an extremely bleak situation. HIV/AIDS awareness remains almost non-existent in urban squatter camps and rural areas, and the alarming rate of infection among South African youth remains the highest in the world. More campaigns and more programmes are required to address persistent behavioural trends, such as multiple sexual partners and alcohol and drug abuse. I entirely agree with the call of the right reverend Prelate the Bishop of Salisbury that the threat of the pandemic should be preached in churches, mosques and other religious forums.
	Of course, there remains a great deal to be done but, 12 months ago, South Africa appeared to be sleepwalking to disaster. That is thankfully not the case today. At long last, the tide has started to turn. I would, however, like to sound a note of caution on the accuracy of the available statistics. Many of your Lordships will be aware of the recent report by UNAIDS, which estimated that 5.4 million South Africans have been infected by HIV—that is, one in every nine of the 45 million. It has also been reported that the HIV/AIDS virus is carried not only by 100,000 of the country's 1 million civil servants but also by a quarter of mineworkers employed by Anglo American.
	I challenge how these noticeably round numbers are calculated. Like anything else, they should be subject to scrutiny. Estimates of infection and death rates are based not on the results of actual testing, which are costly and clearly impractical, but on sparse information fed into computer models. Such systems are patently imperfect.
	The World Health Organisation initially used Epimodel to calculate that 250,000 South Africans had died of HIV/AIDS related causes in 1999. This system was subsequently upgraded to ASSA 600, which concluded that only 143,000 South Africans had died because of the virus in 1999. Towards the end of 2001, the agency then introduced another model, ASSA 2000, which further reduced the total to 92,000.
	Of course, we must take the statistics seriously, but they are estimates, not facts. Last year, it was widely reported that the population of Botswana had fallen from 1.4 million to below 1 million because of HIV/AIDS related deaths. However, a recent census put the population at 1.7 million.
	The HIV/AIDS pandemic remains an immense problem in southern Africa. However, the campaign to control the virus in South Africa and Botswana is, thankfully, starting to make headway. I hope that the focus remains as firmly on prevention as on cure.

The Earl of Sandwich: My Lords, before my noble friend sits down, perhaps he could answer one question. He has given us very encouraging news of the change of heart in South Africa. Does that imply that that is real political leadership from the top?

Lord St John of Bletso: My Lords, the situation is that for some time President Thabo Mbeke has swept the issue of HIV/AIDS under the carpet. Fortunately, through pressure from his colleagues in cabinet and from international organisations, the president has agreed that this is indeed a major problem for which he has to take responsibility. Therefore, I say that the tide has turned.

Baroness Northover: My Lords, I am very glad that the noble Lord, Lord Fowler, has put down this Motion for debate. When he was Secretary of State for Health in the 1980s his efforts in this area were brave and widely admired. I remember that he was also much vilified. Such national leadership is now desperately needed around the world. As most noble Lords seem to feel, the AIDS epidemic is surely one of the greatest challenges of our time. Although the plague of the Middle Ages, to which the noble Lord, Lord Brooke, referred, wiped out whole communities and generated great social unrest, it was not on this scale. It should, however, serve as a warning of what such epidemics can do to the social fabric.
	I listened to the noble Lord, Lord Colwyn, with some interest. When he extracts a tooth from an apparently HIV/AIDS patient, I wonder whether he feels it necessary to take special precautions. I am glad to say that my husband, if operating on an HIV/AIDS patient, does so. But diverse views encourage research which is badly needed, especially if a vaccine is to be developed.
	In my view, AIDS threatens not only to devastate the lives of those infected, but also to destroy societies. As we have heard—I understand the question about the figures—there are perhaps some 40 million to 46 million people living with HIV globally, 30 million of whom live in sub-Saharan Africa. As we have heard, there are at least 14 million AIDS orphans. AIDS is spreading rapidly around the world. There are probably at least 1 million people living with HIV in China and the UN estimates that that may reach 20 million within six years. The fastest growing incidence of the disease is now in eastern Europe, right on our borders.
	So why have we failed to recognise the significance of this catastrophe? Can we see evidence, as the noble Lord, Lord St John, said, of the huge tanker of international concern gradually turning around? We are deluged with news of conferences, communiqués and commitments, but to what extent is money following the pledges? Clearly this disaster is on such a catastrophic scale that even massive efforts do not yet meet what is required.
	Profound changes in behaviour are also required. As the noble Lord, Lord Fowler, has said, prevention is clearly the key to containing the disease. But like him, I am glad that we are now also talking about treatment. Until recently, treatment had seemed an almost impossible dream in much of Africa at least. It was said that there was not the health infrastructure or the drugs required. That has now been recognised as a counsel of despair. Instead we see that prolonging lives is good in itself, but also helps to hold societies together. At the very least it postpones the time when children are abandoned to care for themselves.
	The agreement to provide generic anti-retroviral drugs has been a huge step forward, and is a credit to international institutions. This weekend we heard the excellent news that the US Government will also apparently speed the approval there of cheap ARVs. That is desperately needed. Only 3 per cent of those who need ARV drugs in Africa have access to them. The "3 by 5" initiative of WHO and UNAIDS is ambitious, but not ambitious enough.
	A blueprint for what can be done is surely the ACHAP scheme in Botswana to which the noble Lord, Lord St John, referred. The incidence of AIDS in Botswana is generally around 38 per cent, but as high as 65 per cent among certain groups. A partnership of Merck & Co and the Gates Foundation with the Government of Botswana has committed 100 million dollars to addressing almost every aspect of the AIDS epidemic in Botswana. Almost half of the population of 1.7 million live on only one dollar a day. ACHAP is investing in prevention, education, strengthening capacity and providing care so that all potentially have access to treatment.
	As yet those who are well are not coming forward for testing or for treatment, although information about the disease is being disseminated. Fewer than 10 per cent yet know their status. So it is the very ill who are coming to the clinics. But here the scheme has already made a huge difference, reducing what might have been a 100 per cent death rate among this particular group to 8 per cent.
	However, they are finding that they have enormous problems with capacity—too few doctors and nurses—and they are drawing them in from other countries around. That is clearly something that the international community will have to address. Can the Minister comment on whether there might be schemes for training doctors, nurses and teachers more rapidly, given that they are especially needed and yet they are particularly badly hit by the epidemic?
	Sixty-four per cent of those who are being treated in Botswana are women. The impact of this epidemic is far greater on women than on men. Women and adolescent girls are socially, culturally, biologically and economically more vulnerable. Women are not only at greater risk of contracting the disease, but they also carry the greatest social burden, as caring falls to them, whether as elderly carers or as children.
	Fundamental changes in attitudes towards women are necessary, but I cannot imagine that they will be anything but slow to come. If I can see any bright spot in this epidemic it will be if indeed it causes a shift in the position of women. There are short-term measures that can certainly be taken. Educating girls, supporting carers, developing microbicides with which women may help to protect themselves and changing legal systems so that women can inherit land and property on their husband's death can all be moved forward while pushing for more profound changes in attitudes towards women.
	The worst and the saddest aspect of the AIDS story is surely the plight of the children. I cannot believe that we have taken so little action to help AIDS orphans up to now. As Save the Children has put it,
	"Children are the most affected and the most marginalised in the fight against this epidemic".
	There are the children with HIV. In South Africa there is now a prevalence of over 6 per cent in children between the ages of two and 15. UNAIDS estimates that over half of new infections are occurring in young people between the ages of 15 and 24.
	But in addition children are being orphaned every minute. Fourteen million children under the age of 15 have already been orphaned and this number is projected to double by the end of this decade. In the hardest hit countries in southern Africa, up to one quarter of all children, one in eight of the entire population, is an orphan.
	We clearly have to do what we can to try to support extended families who have taken in orphan children. For a start, the care-giver should never need to have to worry about how to feed those in their care. Free schooling is needed so that children can continue their education and make it less likely that they themselves will fall victim to the disease. Clearly, trying to support children in large extended families or within communities is likely to be far preferable to establishing huge orphanages. But there is already evidence of extended families breaking down under the strain. Society itself is at breaking point. It is better therefore that they receive some care than end up as street children, prostitutes and child soldiers.
	In the Government's last policy statement on AIDS, orphans were mentioned as an effect of AIDS without their needs being addressed. The Government surely must be at the forefront of developing comprehensive plans for these children and not see them simply as some by-product of the disease. I look forward to hearing what the Minister says on this matter.
	Spending by the international community has dramatically increased, but the UN reckons that spending needs at least to double again. Can the Minister tell me how much the Government will be contributing to the Global Fund and when he anticipates the Government will reach 0.7 per cent of GNP donated to aid? I welcome the proposal put forward by the noble Lord, Lord Fowler, that there should be an EU co-ordinator for AIDS. That is a very positive and useful proposal.
	We have to recognise that we are still only at the beginning of the AIDS epidemic and its impact. First, the incidence of HIV rises exponentially. Then the number of AIDS cases rises. Only after that do we see the exponential rise in the impact of the disease. In many areas we are still at the stage of seeing the rise in HIV infection. We therefore know that even if we keep in check the increase in the number of infections, we are still yet to see its huge impact. It is like watching a tidal wave roll in.
	We therefore have to recognise that we are in this for the long term, and that we have to act with a far greater sense of urgency. There is surely no higher priority for DfID. AIDS is already reversing development, so that instead of moving towards the MDGs by 2015, we will simply move away from them. That is why I welcome this debate and all those communications I receive which tell me that there is an ever increasing number of people who realise quite how important this pandemic is for all our futures.

Lord McColl of Dulwich: My Lords, may I also thank the noble Lord, Lord Fowler, for initiating this extremely important debate. It was his characteristic modesty which precluded his mentioning that he was the Secretary of State responsible for this very successful campaign in the 1980s.
	I should declare an interest. I have been president and chairman of the Mildmay centre in Hackney, which was set up in 1986 with the help and encouragement of Lord Shaw. He was of enormous help and encouragement to us. It was the first hospice for people dying of AIDS in Europe. Then at the invitation of president Museveni of Uganda we later set up a similar organisation in Kampala, with the invaluable support of my noble friend Lady Chalker, as mentioned by the noble Earl, Lord Sandwich.
	When the World Health Organisation predicted in 1999 that there would be 27 million people with HIV/AIDS by now, it was thought by many to be scaremongering. The estimate was wrong. The figures today are 50 per cent higher than predicted. The numbers are set to grow even more as infection rates continue to rise especially in countries where poverty, poor health systems and limited resources for prevention and care accelerate the spread of the virus.
	A young Zulu lady from Durban has been working in many districts in this country during the past six months and she has been alarmed by the attitude that she has encountered. Everywhere she goes people give her the impression that they think that AIDS is a problem of the sub-Sahara, but the danger in Europe is very grave indeed.
	A WHO study released this month showed that HIV/AIDS is spreading throughout Europe faster than anywhere else in the world. Almost 2.5 million people on the Continent are affected. In developed countries HIV/AIDS claimed approximately 18,000 lives in the past year. There is increasing evidence that prevention strategies in several high income countries are not keeping pace with the changes occurring in the spread of the disease. These shortcomings are most evident among the marginalised group of populations such as immigrants and refugees.
	The spread is fastest in Eastern Europe where one third of 1 million new cases were identified last year. That is up from 27,000 in 1995. In Eastern Europe and Central Asia the worst affected areas are the Russian Federation, Ukraine and the Baltic states, but the disease continues to spread in other eastern countries such as Belarus, Moldova and Kazakhstan, and more recently in Uzbekistan. It is estimated that 1 million people aged 15 to 49 are living with HIV/AIDS in the Russian Federation.
	Over 1 million people in Asia and the Pacific acquired HIV/AIDS in 2003, bringing the total number to an estimated 7.4 million. This region saw 500,000 AIDS-related deaths in 2003 alone.
	The prevalence of the disease is hard to estimate in these regions due to the vast size and population of the countries. That has the effect of focusing attention towards the prevalence in major urban areas, often obscuring the epidemics in smaller provinces.
	There is also the notion that North Africa and the Middle East have side-stepped the global epidemic, but the latest figures prove that that is not so. It is estimated that 600,000 people now have HIV/AIDS in this region, which killed 45,000 people in 2003 alone. Over 2 million people are now living with HIV/AIDS in Latin America and the Caribbean including 200,000 who contracted the disease in 2003. At least 100,000 people died of AIDS in the same period, which is the highest regional death toll after the sub-Sahara and Asia. It is estimated that approximately 50,000 people are living with HIV/AIDS in the UK, of whom about one-third are thought to be undiagnosed.
	Until 1998, infections acquired in homosexual men were the main exposure category for new infections in the UK. However, by 1999, heterosexually-acquired HIV/AIDS had become the main exposure category for new cases in the UK. That situation has continued. The proportion of infections acquired through injecting drugs has been much smaller in the UK than in many other European countries. That is largely due to the well implemented harm reduction methods—for example, needle replacement programmes.
	The use of highly active anti-retroviral therapy (HAART) has proven effective in delaying associated deaths and the onset of AIDS. However, the decline in the number of cases and deaths in the surveillance data will not necessarily be maintained. Some of the progressions to AIDS or death, which continue to occur in the era of widely-available HAART, may be attributed to patient non-compliance, failure to tolerate a demanding drug regime or the emergence of drug-resistant viral strains.
	In the past 15 years, there has been a great increase in the incidence of HIV/AIDS infection among heterosexuals in the UK. By 2003, the total number infected was nearly 20,000. Infection rates are particularly high in African communities in the UK where, often, one or both of the partners has contracted the infection in Africa before arrival.
	I was very glad that the noble Baroness, Lady Masham, mentioned the withdrawal of support from the children services at the Mildmay centre in Hackney. PCTs will not fund them. I suspect that that is because there are no government targets for the management of those children. Naturally and understandably, PCTs feel obliged to try to concentrate on reaching the targets that have been set by the Government in other areas. Perhaps the Minister would look into that rather sad state of affairs.
	This morning, I was speaking to Mrs Ruth Sims in Uganda, who is the director and founder of the Mildmay centre in Uganda. For many years, she has done wonderful work in Uganda and many other parts of Africa. She said that one of the problems in Uganda is that it has now become clear that many children were infected at birth unbeknown at the time. HIV/AIDS is now becoming manifest in teenagers as old as 18, who picked up the infection at birth. In retrospect, many of them have been ill off and on for most of their lives but they were not diagnosed.
	As the noble Baroness, Lady Northover, mentioned, the number of orphans is putting an intolerable burden on the already extended families, especially in Uganda. For instance, a granny may look after 10 orphans. Then, one of the children becomes sick. That could be the last straw because the granny already goes out to work all day to earn enough money to support the orphans. She does not have time to look after the sick child.
	Of course, making available ARVs (anti-retroviral drugs) is a great help. The problem now is that there are far too few people able to administer those drugs to the children. What is desperately needed is not only ARVs but also palliative care and people on the ground who can look after those unfortunate children and give support at grass-roots level for the elderly grandmothers on whom most of the burden of care falls.
	Another problem that has arisen in Uganda is that the supply of drugs which are necessary to treat the complications of HIV/AIDS has been reduced. In a clinic in the Mildmay centre in Uganda, I saw about 80 HIV/AIDS infected children being treated. Most of them had treatable complications, such as opportunistic infections, toxoplasmosis, PCT, pneumonia and fungal infections, which respond well to relatively cheap drugs. Incidentally, 80 per cent of those children had open TB. Noble Lords have mentioned an incidence of one in three, but in those unfortunate children 80 per cent had open TB.
	One commercial firm is continuing to supply some of the drugs for free, but it is essential that we have enough drugs to treat all those infections. They improve the lives of children so that they then can be treated with ARVs. Will the Minister kindly consider making funds available for those drugs and for palliative care?
	In some countries in Africa the stigma of AIDS is appalling. For instance, as has been mentioned, it is widespread in South Africa. When someone in a family is diagnosed with AIDS, instead of his or her family rallying around, they tend to isolate and ignore the person. In some of the general hospitals in South Africa, as many as 50 per cent of children under the age of 5 attending hospital are HIV positive.
	It has been shown that rates of HIV transmission vary by social standing, especially in the southern United States. The WHO proposes that prevention activities need to be designed with the local epidemiology and the spread and management of the disease in mind. For example, in settings in which HIV/AIDS is largely sexually transmitted, information and education campaigns can save lives. A prime example is Thailand, which has already been mentioned.
	In the fight against HIV/AIDS, the role of heads of state has been crucial. Those presidents who have denied the problem have presided over disasters, as has been mentioned in South Africa. Those who have been honest and have given real leadership are well worth studying.
	From Africa, perhaps we have most to learn from President Museveni—mentioned by the noble Earl, Lord Sandwich—whose campaign has led to a really significant reduction in the incidence of HIV from 31 per cent to 7 per cent among pregnant women. We are not sure whether we can extrapolate that figure to the rest of the population, but, certainly, his leadership and close liaison with schools, Churches and non-government organisations has been inspiring. As has been mentioned already, at the centre of his campaign has been the well known ABC programme; that is abstinence, be faithful in marriage and condoms.
	Some emphasis has been put on the need for education, but that is only part of the answer. A young British lady doctor went to Africa to work for six months. She had an affair and returned with AIDS in spite of being highly educated. The tragedy of the disease is that many people could avoid it by changing their behaviour. Sadly, even if behaviour in many developing countries changed overnight, those countries would still lose one-third of their populations.

Lord Triesman: My Lords, I join everyone in congratulating the noble Lord, Lord Fowler, on securing the debate. His knowledge, compassion and commitment are well known and applauded on all sides of the House. There is no one with a better right to pose the critical questions—a point made by the noble Lord, Lord Brooke, and others, in which I join.
	This is a subject of global importance with massive ramifications. We have had what must certainly be one of the most thought-provoking exchanges of views that I can recall. I shall try to reflect on those views here, but I promise noble Lords that I shall be reflecting on them long after today's debate is over. Some parts of the discussion have been harrowing. The right reverend Prelate the Bishop of Salisbury and the noble Lord, Lord St John of Bletso, also raised issues that have probably moved us all.
	There have been a great many significant recent developments at home and overseas which have signalled an increased, almost unprecedented, focus on the epidemic. I am bound to say, not at great length, to the noble Lord, Lord, Lord Colwyn, that there are always outlying theories in any branch of medicine, but it is inconceivable that we could stand aside from the overwhelming weight of epidemiological research studies across the world and across cultures. There has been a diversity of research and yet a commonality of conclusions. People do not die of AIDS unless they have HIV. It is probably true that other factors such as poverty and malnutrition accelerate the onset of AIDS, but not without HIV. The AIDS pandemic is not just old illnesses. The rapid increase in sickness and death among populations principally made up of groups that are sexually active demonstrates that that is a new phenomenon. Noble Lords who have a great deal more medical experience than I made that point during the debate. As the noble Baroness, Lady Northover, said, there is of course a need for greater research, but we hope that as that research takes place, the AIDS dissidents—if I may describe them in that way—will be receptive to its outcomes.
	World AIDS Day 2003 marked a stepping-up of the UK's political attention to HIV/AIDS, with the launch of our Call for Action. I shall return to the developments around the Government's new HIV/AIDS strategy. We have focused on a number of questions. Those questions relate to our domestic arrangements, but also to the international position; for example, how best can the UK work with its partners? What is the best balance between UK-led action and our support for international action? What is the best balance between multilateral and bilateral research activity? We shall have to discuss in the ways that have been raised in the debate the balance of work between governments, civil society and the private sector. What is the balance between prevention, treatment and care, and impact mitigation? Those are all vital questions. As the noble Baroness, Lady Northover, said, they are big questions and they need some pretty big answers.
	The noble Lord, Lord Fowler—I hope that I am quoting his words accurately; I do not mean to distort them—described the issues as issues of sheer scale, as matters where the sheer scale of the question should be absolutely fundamental to us. The noble Lord, Lord McColl, also placed the right emphasis on these figures. They are truly staggering statistics: 60 million people have been infected with HIV since the late 1970s; 20 million deaths so far; 40 million people living with the virus; 5 million new infections in 2003. I shall try to break those figures down to smaller time capsules: 14,000 people die from AIDS every day; 570 people die an hour; nine people die every minute. One can almost do the sum while we have been holding this debate. Three million people died of AIDS in 2003; five people died every minute; 342 every hour and so on. As noble Lords have pointed out, more than half of new infections occur in young people between 15 and 24 years old. As the noble Baroness, Lady Northover, also said, women and girls are at much heightened risk. That is a fundamental issue in itself.
	The noble Lord, Lord McColl, was quite right to draw our attention to the 2.5 million people with AIDS on the Continent. Eastern Europe is close enough to us and it has grave difficulties. We need to comment on that before we comment on people who are further afield.
	Perhaps I may take up the point about Mildmay. I was not aware until this evening's discussion of all the issues, but I undertake to look into the matter.
	I think that we would all accept that the greatest impact of AIDS so far has been in sub-Saharan Africa. Southern Africa has 30 per cent of infections and only 2 per cent of the world's population, even allowing for the risk of the statistics being not all that we would want them to be. As noble Lords have said, there are fast-growing epidemics in the Russian Federation. Potentially the highest increase is in China and India, in both cases, as has been pointed out, with people not knowing.
	The noble Lord, Lord Brooke, made a very powerful point when he said that our own early experience needs to be conveyed to others, not in any patronising way, but in order to make sure that early lessons can be learnt. The noble Baroness, Lady Stern, said that our experience was and is a model and I agree with her.
	The issues are important and are recognised as such. I shall underline that with a brief quotation from Khadija Moalla, the project manager who has been dealing with many of those issues in the Arab states. He said that it has to be accepted almost like a mathematical axiom that there has been a failure in dealing with HIV/AIDS so far, which implies that we need many new ways of working on those fundamental problems. That is the stark reality that we face.
	Perhaps I may deal briefly with a couple of domestic issues. The noble Baroness, Lady Stern, asked about prisons and about the scope of the law here. I offer her a couple of assurances. A good deal of discussion has taken place about the problems of sharing needles in prison and the issues surrounding the provision of injecting equipment. That is prohibited in prisons at the moment and a fundamental change in policy would be needed.
	As a proportionate response to the issue of sharing needles, the Prison Service is reintroducing disinfecting tablets to prisoners. The London School of Hygiene and Tropical Medicine has been contracted to design and implement a strategy for their introduction in all prison establishments in England and Wales. The programme should have rolled out from April 2004 and I believe that it is doing so. The reintroduction of disinfecting tablets on a trial basis just a couple of years ago has now been evaluated. That project has led to the conclusion that I have just announced to the House.
	The Prison Service also recognises that sex in prisons is a reality and carries a public health dimension. Prison doctors have therefore been advised that they should prescribe condoms to individual prisoners on application if, in their clinical judgment, there is any kind of known risk of HIV infection. Policy probably varies across the prison estate, but it would obviously be better if it were raised to a much better standard in general. There are no plans to introduce needle exchange at present, but that matter is reviewed regularly.
	I thank the noble Baroness, Lady Stern, for drawing the attention of the House to the declaration on prison health which I understand was adopted by the annual conference of the World Health Organisation in Moscow in October 2003. Officials working in the prison health team, which is a joint Home Office and Department of Health unit, are taking forward the reforms to improve prison health care. That unit is also acting as a collaborating centre for the WHO project. It will ensure that officials representing the UK at the next conference in October 2004 are fully briefed on the details of the declaration and will be in a position to look at progress.
	On the legal status of people wilfully or knowingly transmitting HIV, it is not possible at present to confirm that there will be new legislation. My understanding is that prosecution is achieved under existing categories of law, particularly GBH. We would be concerned about the excessive use of legal instruments to protect public health, because the burden of proof in intimate relations is not always an easy matter in tests of law. The carrot-and-stick approach is usually most effective in health promotion HIV projects.
	More broadly, the impact of AIDS, as we have all agreed, is devastating. It is killing development in the developing world. Life expectancy in many African countries is falling to around 30 years of age. Botswana is the worst affected. An upper-middle income country, it faces a decline in life expectancy from 65 in 1990–95 to 40 today and it is projected that it may be 27 by 2010. The country may drop to low income status. Death among young people is undermining the workforce and potential carers. It has also been pointed out in debate that to cope with the crisis, households may be forced to sell off assets, children to go out to work, and there may be a switch to growing lower-value crops.
	There are acute problems in public services. Africa is having to deal with significantly depleted resource capacity. Education and health services are the hardest hit. Teacher absenteeism, let alone the rate of death among young teachers, is dramatically cutting the number of teaching hours across southern Africa. The noble Lord, Lord Fowler, made the dramatic point that the number of teachers dying is outstripping those who are entering the profession.
	Other problems include depleted work forces, lower productivity, economic growth rates decimated, with the private sector equally hard hit. There is a sharp decline in productivity, less resource and what has been described in the course of our debate, if I can put it in slightly different words, as the 1 per cent tipping point, where this becomes catastrophic.
	The social impact is enormous. The fabric of our societies, as the right reverend Prelate said—and he must be right—is an intricate network that binds us together in very subtle ways, and fear finally begins to usurp the binding.
	The noble Earl, Lord Sandwich, and the noble Baroness, Lady Masham, both made points about this. I do not think I can respond in a reasonable amount of time to all those points, but I shall write to noble Lords who have raised the point about the difference between budget support for local initiatives and the way in which we might get a more co-ordinated support where we are trying to assist in single government settings. In some countries, such as Uganda, one model is more appropriate than it would be in Tanzania, where it would not necessarily work as well. There is a degree of subtlety which needs considerable thought, and I shall write to noble Lords on that. I will say in that response why there is relatively little reference to ARVs in the HMG consultation document, although it is covered in other consultation documents. I draw noble Lords' attention to those. HIV and TB are strongly linked, and treatment with ARVs is one of the most fundamental issues.
	Noble Lords raised the question of orphans. There are 14 million AIDS orphans in the world; the figure will rise to 25 million by 2010. Families are being dislocated as children are sent off to live with elderly relatives. Orphans are less likely to attend school. They are more likely to suffer from poor health and malnutrition and are more vulnerable to physical and sexual abuse. The impact is felt long before their parents die, when children, especially girls, have to drop out of school to become carers and take responsibility for farms, household chores and income-generation. We must pay great attention to the rights of orphans—that is one of the central parts of the Government's programme.
	The social consequences could be enormous, with children who have suffered profound distress, with little adult guidance or support, facing very uncertain futures, often in the face of widespread stigma and discrimination. Social breakdown can itself fuel conflict.
	Women shoulder the burden of caring and are less likely to be cared for. They suffer the greater discrimination; they face the greater poverty—unequal inheritance and land rights laws fuel poverty and HIV risk. Women and girls are biologically, socially and economically at the greatest risk of HIV infection. The sexual education of girls is at the heart of DfID's approach. That approach is not always easy because it sometimes has to be taken in countries where there is a great deal of conflict. Getting any kind of help through is not easy, creating a lack of access to information and a breakdown of services. We must address those questions.
	The noble Lord, Lord Chan, talked about some of the information which is available in some of the areas where malaria is important. The Malaria Consortium plays a vital role; the data that it is generating is important for much broader epidemiological and clinical research as well. The noble Lord, Lord St John of Bletso, provided valuable insights into what is happening in South Africa in relation to antiretroviral drugs.
	DfID is giving the highest priority to tackling the HIV/AIDS issue. We have increased our funding to developing countries; we are working with non-governmental, private and multilateral partners to improve prevention, treatment and care programmes. UNAIDS describes DfID as the world's second biggest bilateral donor of HIV/AIDS finance. Bilateral funding on HIV/AIDS and sexual and reproductive health has increased sevenfold over the past six years from £38 million to more than £270 million in 2002–03.
	We were the first bilateral donor government to contribute to the World Health Organisation/UNAIDS 3x5 initiative—to get 3 million people on life-saving anti-retroviral treatment by 2005. Our contribution of £3 million has led to others and we welcome the significant contribution from Canada, announced only last week.
	We are guided by the 3 Ones programme to which I believe a fourth One is about to be added. In each nation, we need a single strategy, so that everyone knows where they are going. We need one national AIDS authority, although I understand that we do not want to kill off initiative and the things done by many of the voluntary bodies. But there needs to be some co-ordination. We want to see one monitoring framework, not least to get the better statistics to which the noble Lord, Lord St John, referred. The fourth One, if it comes along, will be that we want to see donors working through a financial mechanism which will reduce transactional costs.
	We support wide-ranging HIV/AIDS work in 40 countries. Bilateral funding largely supports the national HIV/AIDS strategies of our developing country partners, including Malawi, South Africa and Zambia. We are major donors to the Ugandan Government's poverty eradication programme.
	We work extensively through the multilateral organisations, including UNAIDS, the World Health Organisation and the World Bank. We also support worldwide research initiatives on HIV and sexually transmitted infections. As the noble Lord, Lord Chan, said, capacity-building is vital in all those areas, and it is most vital that what is learned and what is practised in similar countries is among the information that is shared.
	We were a prime mover in setting up the Global Fund to Fight AIDS Tuberculosis and Malaria, and we have committed 280 million dollars over seven years to contribute to long-term stability of funding. I am pleased to announce that there are 58 other nations now making contributions, and contributions are being made through the EC. We are heading towards the 0.7 per cent target. An answer was given to a Question in your Lordships' House only a couple of days ago, and I cannot improve on it. Together, the EU member states and the EC have provided more than 50 per cent of the total funding of the global fund. This is in line with the call from the Prime Minister and President Chirac for Europe to play a full part. A good deal of this money needs to be spent on drugs and palliative care. I will ponder hard the proposal of the noble Lord, Lord McColl, that the amount should be increased.
	Countering the devastating impact on developing countries requires improved access to affordable medicines, good healthcare services and knowledge. This has been a priority, and it is a priority in the partnerships we are striking with India—to respond to another question from the noble Lord, Lord Chan.
	The United Kingdom is providing substantial support—£1.5 billion since 1997. We are doing more in our own health service, although I understand the arguments for doing still more. The GUM clinics have just been given a further £15 million for expenditure on sexual health, and a great deal of that will be going towards AIDS.
	The UK Government have a progressive workplace policy, particularly for staff working overseas, in order to make sure that our approach is consistent, whether people are working here or overseas.
	The Call for Action is the start of a process that will take us beyond our presidency of the EU in 2005. In all of this, working together will involve working with strong leadership—points made by the noble Lords, Lord Fowler, Lord Brooke and Lord McColl. President Museveni, quite rightly, deserves honourable mention. We will be supporting the New Partnership for Africa's Development. We need better funding, and we will be working hard for that. We need better donor co-ordination, and we will be working hard for that.
	We will be working hard with those who have also made contributions which are not governmental—the Bill and Melinda Gates Foundation, Bill Clinton's charity, the Rockefeller Foundation, Merck, the Kaiser Family Foundation and a number of others, who are such important players.
	We need better HIV/AIDS programmes. This is the purpose of the major areas with which we are concerned. We want to work to eliminate global poverty, which underpins our commitment to addressing HIV/AIDS. We want to work specifically on the problems of women and girls because of their particular susceptibility, which has been mentioned. We want to work on marginalised groups, defined by poverty, gender, ethnicity, age, sexuality and disability. We want to make sure that research in our own country moves ahead because this is a great centre of research—and research is one of the most helpful elements that can be contributed to this debate. I thank all noble Lords who have taken part.

Lord Fowler: My Lords, this has been an outstanding debate. Dare I say that I think it is a debate that could only have taken place in the House of Lords because of the experience that has been shown during it? I would like to thank all noble Lords for their contributions. I agreed with almost all those who spoke. I very much agreed with the right reverend Prelate the Bishop of Salisbury when, in his very important speech, he said that HIV/AIDS cannot be allowed to slip from the public agenda and that it must go to the top of governments' agendas. I think he is entirely right to say that.
	My noble friend Lord Colwyn said, in the most genial way, that he did not think that I would agree with much of what he would say. He was right on that. He said that there is so much that we do not understand about HIV/AIDS. It is true that we still have no cure and no vaccine. But we know what can be done to prevent it and we know what can be done to treat it. My noble friend Lord McColl and the noble Earl, Lord Sandwich, both pointed to the experience in Uganda where the incidence of HIV has been brought down. My noble friend Lord Brooke, in his elegant speech, also pointed to Brazil.
	It would be wrong of me to try to summarise what all noble Lords have said. There were important contributions from each of them; for example, from the noble Baroness, Lady Stern, with her vast experience on the position in prisons; from the noble Baroness, Lady Masham, on the need to have a more outward going campaign in the UK; and from the noble Baroness, Lady Northover, on orphans. I was fascinated by the speeches of the noble Lords, Lord St John of Bletso and Lord Chan, about South Africa.
	Lastly, I would like to thank the Minister for his thoughtful reply. I agreed with much of the diagnosis. If I may gently say so, I was a little less convinced on the new action that the Government intend to take. We will have to study the figures that came out in a shower at the end of the speech. I am always suspicious about figures that talk about spending over seven years and what that means year by year. However, I thank him. We still have a long way to go—I think that we agree on that—both in policy at home and overseas. We will support all the Government's genuine efforts but we will also not hesitate to point out when the Government are not doing enough. That is my position. In other words, I think we will debate this matter again. I beg leave to withdraw the Motion for Papers.

Motion for Papers, by leave, withdrawn.

Medicines for Human Use (Clinical Trials) Regulations 2004

Earl Howe: rose to move, That an humble Address be presented to Her Majesty praying that the regulations, laid before the House on 1 April, be annulled (S.I. 2004/1031) [4th Report from the Merits Committee].

Earl Howe: My Lords, the regulations to which this Prayer relates are primarily aimed at transposing into UK law the provisions of the EC Clinical Trials Directive 2001. I first became aware of the directive in the middle of last year when the Government were consulting on its implementation. At that time the concerns we were hearing were mainly those of the medical research charities and academics who were fearful that a combination of bureaucracy, excessive costs and procedural inflexibility would finish off a great deal of collaboratively funded non-commercial clinical research in the UK. It is fair to say that, thanks to the work of Ministers and officials, to which I pay tribute, those worries have diminished somewhat.
	There is still a concern, reflected in the recent report of the Merits Committee, about what effect a commission directive on good clinical practice might have on the UK when it is eventually issued. There is also a strong feeling that the aims and content of the directive should be reviewed by the Commission at the earliest opportunity, particularly in relation to non-commercial clinical trials. The Minister may care to comment on those matters. However, some of the other earlier points of contention are no longer so salient and I do not intend to spend time on them now.
	The concerns that I want to raise this evening fall under two main headings: the rules for clinical trials as they affect mentally incapacitated adults and the future independence and functions of research ethics committees. The way that these two issues have been treated in the regulations has, in my view, profound implications for the future of clinical trials in this country. I hope that the Minister can provide some sturdy reassurances on these matters. He needs to know that there is real dismay and alarm out there, to a degree that I am not certain I can reflect adequately in the space of a few minutes.
	Let me start with mental incapacity. Paragraph 2 in Part 1 of Schedule 1 introduces into UK law for the first time the concept of a legal representative who may give consent for an adult lacking capacity to be entered into a clinical trial. It is the physician with responsibility for the adult's healthcare who is given the power to choose who should act as the person's legal representative in cases where this is not already clear. In the absence of anyone able to assume the role of personal legal representative, the physician may himself act in that role or alternatively may nominate anyone he chooses from the hospital or healthcare provider concerned.
	It seems extraordinary that this element of the regulations should have been brought forward in advance of the introduction of the Mental Incapacity Bill. The whole area of medical research and mentally incapacitated patients is surely one to which only primary legislation can do full justice. The safeguards that should govern medical research in these circumstances need to be examined with the greatest care by both Houses of Parliament. Changing the law to enable one adult to decide what happens to another adult is a major matter. It is not a change appropriate to regulations.
	Equally, it is a change that is fraught with danger. One cannot just appoint anyone to take a decision about whether a person should take part in a clinical trial. Clinical trials carry risks as well as potential benefits. The person taking the decision must be capable of weighing the risks and benefits dispassionately to determine whether participating in the trial is in the patient's best interest. Publicly available clinical trial data is not always a reliable indicator of risk.
	The decision maker needs to make an informed judgment as well as to be independent of the process. Is the patient's doctor independent of the process? If he is a hospital doctor and the researchers are friends and colleagues working alongside him, he may well not be independent in the truest sense. What about a nominee of the NHS trust? I am very worried that the regulations before us leave it completely open as to who exactly may find himself taking what could be momentous decisions on behalf of a mentally incapacitated individual. Technically, the regulations would allow the receptionist on an A&E ward to act as the decision-taker.
	If there are worries about mentally incapacitated adults in clinical trials, greater still are the worries relating to trials done on children where parental consent is not sought. As someone recently put it to me, if the researchers are in a hurry to find people to take part in a trial, they surely will not go to the family for consent. They will go straight to the doctor who is looking after the patient. What if the family find out too late what has happened and the trial had turned out badly? Mark my words, the moment a decision of this sort goes wrong, the balloon will go up. Negative publicity about a clinical trial could set back medical research for as long a time—and as badly—as the events at Alder Hey.
	Why have the Government rushed into this and why have they not waited for the Mental Incapacity Bill for a full debate? The EU Clinical Trials Directive was designed as a harmonising measure, but the emphasis within it is very much on the protection of those who act as research subjects. It is therefore ironic in the extreme that Ministers should have allowed the protection of children and mentally incapacitated adults to be left so wide open.
	Let me move to the issue of research ethics committees. These regulations are supposed to embody the content of the EU directive, but they are stuffed full of measures that are completely absent from the EU legislation. A prime example is the creation of the United Kingdom Ethics Committee Authority.
	Who comprises this new authority? It consists of the Secretary of State for Health, the National Assembly for Wales, Scottish Ministers and the Department of Health, Social Services and Public Safety for Northern Ireland. With a make-up like that, I defy anyone to say that this is not a political body. It clearly is.
	What powers does it have? It has the power to set up an ethics committee, abolish an ethics committee, recognise an existing committee, decline to recognise one or revoke a recognition of a committee if it is necessary or expedient to do so. In other words, the authority can abolish any ethics committee for any reason at all and set up another one whenever it chooses.
	It also appoints the chairman, vice-chairman, alternative vice-chairman and all the members of NHS ethics committees. One of the key characteristics of ethics committees is their independence from politics, whether national, local or commercial. Indeed, independence of our ECs is an express requirement of the directive. We are looking here at the politicisation of ethics committees and hence the removal of their independence. I know that the Minister disputes that interpretation, but what other conclusion can we reach when the UKECA is being given such sweeping powers?
	The creation of UKECA has enormous implications for medical research. Already over recent months we have witnessed the migration of large amounts of clinical trial work from the UK to other countries in Europe. The moment that foreign regulatory authorities start to regard UK ethics committees as lacking in independence there will only be one consequence. We shall see the flight of clinical trials from this country accelerate.
	Setting up UKECA in this form is not only unnecessary but also potentially very damaging to our national interests. Of all countries in the world with a reputable medical research sector, the UK is alone in its decision to exercise political control over its ethics committees. It is a mistake.
	There is a further respect in which the regulations unnecessarily restrict the freedom of ethics committees. The Helsinki Declaration contains a set of ethical principles to which all clinical trials must adhere. That declaration is referred to in Schedule 1, but it is defined in the terms of an out-of-date version.
	Why does that matter? The Helsinki Declaration was radically rewritten in 2000. The importance of that rewrite is demonstrated sufficiently by one example, that of research subjects who lack capacity. On this issue, the 2000 version says:
	"These groups should not be included in research unless the research is necessary to promote the health of the population represented and this research cannot instead be performed on legally competent persons".
	That restriction does not appear in the earlier version of the Helsinki Declaration; nor does it appear in Schedule 1 of these regulations.
	The regulations are broadly enough written that if, for example, someone was trying out a new antibiotic for chest infections and had access to a captive population of demented patients on a geriatric ward, it would be permissible to use them. An ethics committee that looked to the 2000 version of the Helsinki Declaration and decided not to permit such a trial to go ahead would be open to legal challenge.
	Why are committees being forced into this position? Even ethics committees in Scotland are having their hands tied in this fashion, despite the fact that Scottish law—the Adults with Incapacity (Scotland) Act 2000—runs expressly contrary to the regulations on this important issue.
	We have already seen the way that the wind is blowing for ethics committees. COREC—the Central Office for Research Ethics Committees—has taken upon itself to decide that most research ethics committees will not in future be allowed to review clinical trials, even though they may have done so up to now without a problem. Only those RECs that are recognised under the regulations will be allowed to do so. The basis of recognition is still unclear.
	I have received representations from a number of RECs around the country who are appalled and bewildered at COREC's approach, which they strongly believe puts at risk the future of phase one drugs trials in the UK.
	It is perhaps not appreciated that up until now the system of ethical approval for clinical trials has effectively amounted to a dual safeguard on patient safety. In the past, when a proposal came forward for a clinical trial to be carried out in a number of centres, a multi-centre REC would initially review that research proposal and the local REC would then review it as suitable for local application. While this second review had an obvious time cost attached to it, its benefits for patients were repeatedly proven.
	I have been given numerous examples of errors and avoidable disasters identified by a local REC in research proposals that had previously been vetted and passed. If the new rules had been in operation, these avoidable errors would not have been identified. Only a few committees—but 30 out of some 200—are being allowed to look at research proposals, with the result that local RECs can only act as rubber stamps. If a research proposal has been agreed by a more remote committee elsewhere, there is no opportunity for a local committee to make a site-specific assessment of that proposal.
	Why are so many RECs being denied recognition? As far as I am aware, nobody has assessed them to be incompetent to do the job that they have been doing hitherto. We are looking at centralisation for its own sake. Nothing in the directive obliges us to adopt this kind of approach.
	It is an approach that has the potential not only to curtail and destabilise clinical trial work in this country, but on top of that to place patients at unnecessary risk. But when RECs have tried to put this point of view to COREC, their letters have either not been answered or been dismissed out of hand. That cannot be the way to carry on.
	I view these regulations with deep misgivings. In the words of one ethics committee that has written to me, they represent hasty, poorly consulted and poorly drafted legislation. By and large this is not the fault of the European directive. The fault lies at home.
	If they act quickly, Ministers can still put things right. But time is now of the essence. I beg to move.
	Moved, That an Humble Address be presented to Her Majesty praying that the regulations, laid before the House on 1 April, be annulled (S.I. 2004/1031). [4th Report from the Merits Committee]—(Earl Howe.)

Lord Clement-Jones: My Lords, I rise also to support the humble Address that the noble Earl, Lord Howe, has put forward.
	We are all agreed that this is a deeply unsatisfactory means of incorporating an EU directive into UK law. We are having to pray against a set of regulations, rather than having primary legislation with a Bill that we can amend as we go along and probe the Government's gold-plating of an EU directive in this way. We either have to swallow it whole or we have to spit it out whole.
	Unfortunately, I share the opinion of the noble Earl, Lord Howe, that these regulations are extremely defective—perhaps not on the original grounds put forward by many research institutions and even the pharmaceutical industry itself, but for many of the reasons set out by the noble Earl. Some of the directive's defects result from the very little consultation done by the European Commission. Some of the saving grace of the situation is that the regulations may be amended in due course, as the Government themselves have admitted.
	In passing, I would commend some of the words used by the Merits of Statutory Instruments Committee, chaired by the noble Lord, Lord Hunt, when it invited the Government to explain to what extent and how the many concerns raised about the directive and these regulations have been met and whether any remain outstanding. But, of course, the initiative had to remain with the Opposition in ensuring that a Prayer was laid to have the debate. Again, that is deeply unsatisfactory.
	I thank the Minister for his very close personal interest in the discussion on these regulations, and for his updating correspondence as the regulations have been changed in response to many of the concerns. As the noble Earl, Lord Howe, said, there have been concerns that the regulations could impinge on current practices and that, rather than achieve the goal of harmonising and simplifying the conduct of clinical trials in Europe, it would make them increasingly difficult to conduct and create a more risk-averse culture, in the words of Cancer Research UK.
	As is well known, we have a very high proportion of the worldwide spending on pharmaceutical research—indeed, some 9 per cent—and we have a higher proportion of publicly funded collaborative clinical trials than other European countries. So if these regulations are defective, the effects on the UK will undoubtedly be greater. We are a world leader and therefore our position could be at risk.
	We also have a situation where many clinical trials in the UK are undertaken by independent, non-commercial and non-profit institutions on the basis of educational or unrestricted research grants. Again, that position must be safeguarded in these regulations.
	It is very interesting to note that the European Organisation for Research and Treatment of Cancer has raised a number of issues concerning the way in which research is carried out as part of clinical trials which may be part of the ordinary course of treatment. It is very difficult to judge on the face of it whether its concerns are met by the amendments made to the regulations, but it says:
	"In some instances . . . the pharmaceutical industry may provide the drug(s) and help academic research usually because the drug(s) has a recent marketing authorisation. The industry may not be willing to do so in the future if this is perceived by competent authorities as some sort of sponsorship of the trial. So in the worse case scenario (industry cannot provide the drug and marketed drugs cannot be used but in their registered indication/schedule) 61 per cent of all EORTC trials won't take place anymore".
	I know that there have been discussions, and the note put together by the Department of Health and the MRHA seems to negative that, I think at paragraph 6. However, it is precisely those detailed but extremely important areas that need to be teased out in the course of discussion today. There are a number of other aspects as well.
	There has been considerable discussion about the aspect of single sponsorship. There was concern that the EU directive required a single sponsor for research and that that was incompatible with the UK tradition of collaborative, multi-centre, publicly funded clinical trials where pharmaceutical companies may sponsor academic institutions through research grants or where academics may jointly administer a clinical trial within the NHS. It appears on the face of it that the regulations have been amended to ensure that that is not as rigid as it appears at first sight. It would be helpful if the Minister would give us assurances us that that situation has been cured.
	Then again, a lot of concerns have been raised about the increased cost of running clinical trials and the fact that the regulations will increase those. If there are additional costs, they will not increase patient protection. That was certainly the assessment of Cancer Research UK of the MRHA partial regulatory impact assessment. Higher costs in turn will lead to fewer trials and fewer opportunities for research across the board. Generally, there is a belief that the new processes for monitoring, authorising and administering trials may well discourage researchers from undertaking clinical trails, simply as a result of the additional paperwork and the administration required. I believe that many of those concerns have been allayed but I would like to hear from the Minister in what respect he believes that that is the case.
	The noble Earl, Lord Howe, raised a number of points that seemed to me not to have been addressed adequately, which revolve around a number of very important areas. He made a powerful case in respect of the three areas he mentioned. On the question of the independence of research ethics committees, I shall not go through the entire argument that he made; it would be fruitless to do so when he has made it so well. However, the fact is that UKECA has the power effectively to control the RECs. UKECA has the power to set them up, as the noble Earl said, to abolish them, to make restrictions on their work and to appoint all their members. As has been pointed out, that does not seem to square with the EU clinical trials directive itself. If that is not gold-plating and if that is not the Government taking an opportunity to control RECs, I do not know what is.
	I believe that the Minister has given assurances that appointments to RECs will be made locally, but he has not explained quite how that is going to happen. As the Minister knows, I have raised a number of questions about the Central Office for Research Ethics Committees and its operation, particularly about its seeming inability to consult adequately over a very wide range of extremely important areas, particularly in terms of standing operating procedures, training and accreditation. There is considerable concern about COREC's role. If COREC is effectively to supervise that local appointment, that will be of some considerable concern to research ethics committees. That relationship is not good; I hope the Minister is fully aware of that.
	There is a potential conflict of interest between COREC's role as an appointer or at least an approver of appointments and the fact that the head of COREC reports to the person with responsibility for oversight of research and development in the NHS. That does not seem a particularly apposite place for the head of COREC to report to. Those are considerable points.
	The noble Earl, Lord Howe, mentioned the important point about the out-of-date ethical guidelines. I hope that the flexibility indicated in the Minister's correspondence that there may be amendments to the regulations in due course will cure that problem. But the 1996 version of the Helsinki declaration is far less adequate than the 2000 version. The noble Earl, Lord Howe, gave a clear example.
	At the moment it would be possible for a pharmaceutical company to sponsor trials of a new drug in this country which it had no intention of marketing here. There would be no ability for the research ethics committee to turn down such a proposal for research in those circumstances because it would be permissible under the 1996 declaration, so there are considerable flaws in that situation. The noble Earl, Lord Howe, made a strong case on the legal representatives for adults who lack capacity and children for whom no one has parental responsibility.
	I recognise that the Government have made welcome changes to the regulations and that to some extent we are in an interim situation. I also recognise that in EU terms, in the words of the saying, we would not have started from here. But the Government must bear responsibility for the additions, changes and inconsistencies that they are responsible for drafting into the regulations. That is the fundamental area on which these Benches object to the regulations.

Lord Carter: My Lords, I shall say a few words on the regulations as a result of my chairmanship of the Joint Select Committee on the Draft Mental Incapacity Bill. In our deliberations we gave a great deal of thought to the problem of research on people who lack the capacity to give consent to that research as a result of physical or mental impairment. I would like to say a few words about the relationship of those regulations to our considerations on the draft Mental Incapacity Bill.
	The main reference to the role of ethics committees seems to be in Regulation 15(5) and 15(7) on page 17. Regulation 15(5)(h) states:
	"if the subjects are to include persons incapable of giving informed consent, whether the research is justified having regard to the conditions and principles specified in Part 5 of Schedule 1"—
	I shall come back to that because it is a crucial part of the regulation. It also requires the ethics committee, if it does not have a member with professional expertise in the treatment of conditions where there is research on people with impairment, to add someone with that ability to the committee.
	The most important provisions are in parts 1 and 5 of Schedule 1. As we heard, part 1 defines a legal representative. I shall not say any more about that—I shall leave the Minister to reply to the cogent points made by the noble Earl, Lord Howe. The crucial part of the regulations regarding people who lack capacity is on page 44 in part 5 of Schedule 1, "Conditions and principles which apply in relation to an incapacitated adult". It sets out clearly the 11 conditions and four principles.
	I wish to draw particular attention to condition 9, which applies to an incapacitated adult who is to take part in research. It states:
	"There are grounds for expecting that administering the medicinal product to be tested in the trial will produce a benefit to the subject outweighing the risks or produce no risk at all".
	I presume that the subject is the person with incapacity who is taking part in the trial.
	That answers the point made by the noble Earl, Lord Howe, about the group with dementia having a flu drug or an antibiotic tested on them, because under condition 9 it has to produce a benefit for the person taking part in the trial. If that is the case, does that mean that clinical trials of medicines cannot be conducted to give benefit to a class of people with a clinical condition, for example, Alzheimer's? Must they be conducted only on people who lack capacity if the clinical trial is of benefit to the individual incapacitated person who is taking part in the trial? As the measure is worded, presumably it will not be possible to give a placebo to an incapacitated person who is participating in a trial.
	I turn briefly to the Joint Select Committee report on the draft Mental Incapacity Bill. The committee flagged up the possible effects of European directives on medical research. Paragraph 285 states:
	"Our attention has also been drawn to the European Clinical Trials Directive 2001 . . . While this Directive is limited to trials of pharmaceutical products"—
	which is what we are talking about—
	"it is possible that future European Directives may extend to other forms of medical research and trials of innovative treatment. There is therefore an argument to include in the draft Bill"—
	or the full Bill when it finally comes forward—
	"requirements for the authorisation and supervision of research involving people without capacity to consent, in order to comply with the Clinical Trials Directive and any relevant future European Directives".
	That was the point that the noble Earl, Lord Howe, was making about primary legislation. I shall leave the Minister to deal with that.
	We in the committee were concerned about forbidding research on people without capacity where that research would not benefit them directly but would benefit others. I used the example of Alzheimer's disease in that regard. We were thinking here not of trials involving drugs but research on the results of blood samples, DNA samples and other comparatively harmless aspects of research that might be required to be carried out on someone with a condition such as Alzheimer's disease. That research might not benefit the people who were giving the blood sample or whatever, but would perhaps be of benefit to the class of people as a whole. We said in paragraph 283:
	"When a person lacks the capacity to give consent, they should only be involved with medical research, if it is either in their best interests"—
	which I think is in the regulations where reference is made to it being of benefit to them directly—
	"or if it is the only method of conducting research into their particular condition and everyone involved with the person is satisfied that this is a non-exploitative proposal which will not harm or distress the individual involved".

Earl Howe: My Lords, I am grateful to the noble Lord for giving way. That is a rather different point from the requirement in the Helsinki Declaration. That says that mentally incapacitated patients should not be included in research at all unless the research is necessary to promote their own health, and you cannot do the research on any mentally competent adult. So there is, as it were, a double condition on it.

Lord Carter: My Lords, I was just about to come to that point. I shall deal with that in a moment.
	So far as I can see the regulations seem to move away from the approach I have just described by requiring that the clinical trial of a medicine can be of benefit to the individual with incapacity only if he or she is included in the trial. That tightens up the controls as compared to what we were saying in our report. I can understand that where trials of medicines are concerned but I am not sure that it is applicable in the case of blood or DNA samples.
	To conclude, we on the Select Committee were concerned to set out the key principles that should be observed when considering research on those lacking the capacity to consent to the research. That is the point that the noble Earl, Lord Howe, has just made. We set out at paragraph 289 what we thought were the key principles enshrined by the World Medical Association. They should include the following:
	"research involving people who may be incapacitated must be reviewed by a properly established and independent ethics committee and can only proceed if ethical permission is granted".
	That is in the regulations. The paragraph continues,
	"where a person has the capacity to consent then his decision whether or not to partake in research must be respected".
	That is in the regulations.
	Paragraph 289 continues,
	"considerable care should be taken to ensure that under these circumstances consent to participate was freely given and not a consequence of coercion. The inclusion of people in research, who lacked the capacity to consent, must only occur when such research has the potential for direct benefit to those with that particular problem and could not have been done through the involvement of those with capacity".
	I think that answers the point that the noble Earl, Lord Howe, has just made.
	Paragraph 289 continues,
	"those undertaking research involving people lacking the capacity to consent must respect any indications that a person did not wish to participate (i.e. was dissenting)"—
	I believe that is in the regulations—
	"and any discomfort or risk involved in the research must be, at the most, minimal".
	We then go on to state in some detail what should be in the codes of practice to accompany the Mental Incapacity Bill.
	As far as I can see, the regulations are in line with the recommendations that we made, with the exception, as I have said, of the provision that research has to be for the direct benefit of the person without capacity who was taking part in the clinical trial of drugs, as a result of decisions that are taken by others on his behalf. I think that I can understand the reasoning regarding drug trials, but in the wider area of research it would have to be considered for the benefit of a whole class of people, not just for individuals.

Baroness Knight of Collingtree: My Lords, I have read carefully the wordy statutory instrument right through, and it gives me cause for severe concern about the principle that it establishes.
	However disappointing this may be to scientists whose primary, and certainly not ignoble, aim is to discover cures for sick people, it can never be right in any circumstances to use mentally handicapped people as experimental material without their consent. Most cannot give it anyway, but that is no excuse. Hitler did that and the world rightly condemned him. It appals me that we now propose to emulate him.
	There are pages and pages of S.I. 1031 devoted to the ethical committees, the strict regulations, the investigators, the licensing authorities and the official guidelines, but the bottom line is that mentally handicapped people are to be used for research and experimentation without their agreement. Nothing in the so-called "safeguards" alters that.
	Yet, the statutory instrument acknowledges that the experiments that it permits might well be sufficiently dangerous to the human guinea pig as to cause death. The document actually says that. On page 27, it specifies what should happen,
	"when death of the subject results",
	which brings me to another point. On page 4 the statutory instrument calls the person undergoing such research a,
	"human subject".
	Well, that rather gives the game away. Once one starts referring to human beings as "human subjects", it is clear that one regards them as sub-standard objects. We really cannot agree to that.
	Some people are concerned that the regulations for legal interpretation are flawed because they are so wide and institute a major change in the law. My noble friend Lord Howe dealt brilliantly with that point, which I know is causing considerable concern outside this House. Other people are prepared to agree with the proposals as long as such research can only be allowed if it will benefit the person who is actually enduring the experiment. The noble Lord, Lord Carter, drew our attention to Part 5, paragraph 9, on page 44, and said that the point may be covered by that part of the statutory instrument. That is disputed outside and we must be clear that, so far, it has not managed to ease the concern that has been expressed.
	I have to admit that, even if there was action both on that point and the legal point, I would still have objections to the statutory instrument, because I have much bitter personal experience of how promises in this place are broken to achieve objectives. When we were debating the Abortion Bill in 1967—and I remember it vividly, because it was the first major Bill in which I was involved—it got through Parliament because certain firm promises were made.
	"There will never be abortion on demand if we pass this Bill," they said. "Never. What an extraordinary suggestion!" And yet everybody knows we certainly have abortion on demand today. "The number of abortions will not rise at all," they said. "They will just happen in nice, clean hospitals instead of on nasty, dirty kitchen tables. It will be perfectly alright and the numbers will not rise." Will not rise? I understand now that we have so far got rid of 6 million babies. Nobody suggests we ever did that prior to the Abortion Bill.
	There was another argument, and I put forward a particular amendment about this point. "Using aborted babies for experimentation," they said, "will never be allowed. Never." Well, everybody knows that it happens all the time today, in spite of that promise.
	I remember, too, that they said "Why do you worry the House in this way? Of course abortion will not be carried out for minor medical deficiencies in the child." Remember the case of the child recently aborted because he had a cleft palate? That is not the first case. Members opposite may frown, but I am only telling the truth. These things were told to us when we were debating that Bill and, because of the promises made, the Bill was passed. Every single promise has been broken. This experience teaches me that, however well intentioned, such promises, I am afraid, are made to be broken.
	We should not be muddled about what we mean by "research". If an Alzheimer's sufferer has been given all available medicines for that condition and is still no better, and then another medicine comes on to the market, it cannot be called research to offer that medicine to him or her, suggesting that the new tablet might help. That is not research. That is trying a new tablet, and maybe it will help. But it was research when a group went to Porton Down, having volunteered to be tested in an endeavour to find a cure for the common cold, and were subsequently given sarin.
	It is incorrect to claim that scientists will be able to do research only if we permit these changes. Only last week, doctors at the Brain Research Institute at the University of California announced that they had made a significant breakthrough in the treatment of Alzheimer's, achieved without any of the changes now before us. It was an extremely important and interesting development of the knowledge of what happens to the brain in Alzheimer's, so it is not the case that only these researches are going to help.
	I invite the Minister to alter slightly the reply he gave to me on 5 May. He said:
	"Those conducting trials must obtain informed consent from all participants".—[Official Report, 5/5/04; col. 1097]
	Would that it were so. If this were the case, your Lordships would be blessed by my silence. It is the crux of my case that the statutory instrument says exactly the opposite.
	Finally, I found it rather sneaky to introduce this statutory instrument—initially, as my noble friend Earl Howe has said, clearly part of the draft Mental Incapacity Bill—on the very day the House rose for the Easter Recess. If the Government hoped that that subterfuge would mean it would not be noticed in the plethora of bonnets, eggs and 10 days off, they were wrong. But it so easily could have slipped through because of the way it was introduced. I was informed in an Answer to a Written Question that this happened because there was a directive from our masters, the EU. Well, in my eyes, that does not improve it.

Lord Turnberg: My Lords, I want to speak briefly in favour of the regulations as they stand. First, the noble Earl, Lord Howe, raised some important questions about mentally incapacitated patients and ethics committees. I do not want to enter too far into the debate about mentally incapacitated patients. The noble Lord, Lord Carter, dealt with them at least in part and I shall read his comments with interest. I shall also be interested to hear what the Minister has to say.
	However, I must point out that if research on mentally incapacitated patients were not done, we would never develop new treatments for Alzheimer's disease or other mental illnesses. It is therefore essential that we undertake research on them in one form or another. If they cannot give consent, we have a catch-22 situation; they cannot give consent, yet research is essential if we are to treat them. For reasons other than wanting to find a treatment for mentally incapacitated patients, no one in his right mind would want to undertake research on patients who could not give their consent. It is done on patients who are able to give consent. Indeed, giving a cancer therapy or nasty treatment to mentally incapacitated patients without their consent would never get past first base with any ethics committee. Therefore, one would want to undertake only research for those particular patients and I am not sure that the background to the points raised by the noble Earl is correct.
	With regard to the ethics committees, we have a problem with multi-centre trials, which is why there has been an attempt at rationalising the situation. It is that research or a set of researches goes to a multi-centre research ethics committee and then to a whole series—perhaps 20, 30 or 40—of research ethics committees at the local level. That means that it can take, and has taken, up to two years before a trial can begin. That delay is of course unconscionable and it is the reason why there has been an attempt to rationalise the process so that there is a limited number of ethics committees. How many ethics committees do we really need to undertake ethical review? I am not therefore entirely in tune with what the noble Earl has suggested.
	I believe that the regulations do a reasonable job of achieving the two major aims; maintaining the safety of patients engaged in clinical trials, which is paramount, while ensuring that good, valid clinical research can be pursued without unnecessary—unnecessary—hindrance.
	These regulations are infinitely better than what was once threatened in the draft directive which emanated from the European Commission. I want to place on record my unbound gratitude to my noble friend the Minister and his officials for the enormous amount of work he did in heading off the Commission. He did so by drawing its attention to the potential damage to its proposals for research.
	There are several links in the chain which binds researchers and which ensure that clinical trials are conducted safely and ethically. First, those who fund non-commercial research, largely the Medical Research Council and the medical research charities—here I must express and interest as scientific adviser to the Association of Medical Research Charities—put proposals for grants through a rigorous appraisal using independent referees. That involves an assessment of whether the research is reasonable and can be expected to produce reasonable results that are favourable to patients, and so on. Then, of course, all proposals must be subjected to close examination by research ethics committees. That is not a trivial process, especially for multi-centred trials. Then a sponsor must take responsibility for monitoring the research to ensure that it is being done safely and responsibly. Of course, the employers—the universities and the NHS—have a legal responsibility for the behaviour of their employees. They, too, have codes of good practice for this purpose.
	All those safeguards already exist in one form or another. The regulations now bring them together in a legal framework with the Medicines and Healthcare products Regulatory Agency—the MHRA. It will obviously be important that the MHRA consults widely with the research and other communities and that it does not wield a heavy axe. I am reasonably confident that it will behave appropriately.
	I believe that the regulations are a reasonable and rational set of proposals. It seems that, within the research community at large—although not everyone is ecstatic about everything; they never are—the vast majority are heaving a collective sigh of relief that what we now have is acceptable and infinitely preferable to what we might have had in the Commission's original proposals. That, too, is the view of the medical research charities, which have the patient's view right at their heart. They are, after all, set up by, and are entirely dependent on the support of, the patients, and they, too, are keen to see these regulations in place.

Lord Warner: My Lords, I am glad to have this opportunity to explain the Government's position on these regulations, which transpose the Clinical Trials Directive into UK law. The regulations came into force on 1 May 2004. I have to say to the noble Baroness, Lady Knight, that I do not believe we were trying to slip anything through by subterfuge. The material in these regulations has been around for an extremely long time and has been much debated. I shall try briefly to take people through some of the history.
	The Government support the aims of the directive. They are: to protect the safety, rights and integrity of trial participants; to ensure that the results of trials are reliable; and to facilitate the development of new medicines within the European Community. Listening to some parts of the debate, it would be easy to forget those objectives.
	We successfully negotiated a model for regulation similar to that already in place in the UK, and we resisted attempts in Brussels to introduce unnecessary bureaucracy and an overly prescriptive approach to regulation. I am particularly grateful to my noble friend Lord Turnberg for his kind remarks about the work that the Department of Health carried out in this area.
	I believe that the regulations achieve a proper balance. They safeguard the rights of clinical trial participants and minimise the regulatory impact on those who carry them out. We have asked the Pharmaceutical Industry Competitiveness Task Force, the Biosciences Leadership Council, the Department of Health and the MRC to monitor the impact of the directive on different sectors. We have a good Department of Health and MRC joint working party, which involves a wide range of research interests, and we shall look to that to continue to help us in this area.
	We shall continue to work with all the sectors to keep issues under review. I can assure noble Lords that my door is always open if people want to bring to our attention their concerns. However, we must give the regulations a chance to work. We need to let them bed down and not become too excited about all the terrible things which people think may happen. We must see them working in practice, and we believe that they will be a good set of regulations.
	Clinical trials make an important contribution to public health. They are the scientific basis for the use of new medicines and for new ways of administering existing medicines. The noble Earl, Lord Howe, referred—I thought, slightly excitedly—to the number of clinical trials that are fleeing from this country. The evidence suggests that the number of clinical trials conducted in the UK has not decreased. It is true that the number of clinical trials worldwide has increased and to some extent it is inevitable that the UK percentage in that larger volume of clinical trials may have reduced. The Pharmaceutical Industry Competitiveness Task Force (PICTF), which I mentioned earlier, is monitoring the number of trials and the reasons why companies may use other countries as well as the UK. The reasons are multi-faceted.
	The clinical trials also contribute considerably to our economic wealth. The UK pharmaceutical industry produced a positive trade balance of £2.6 billion in 2002 and the industry spent £3 billion on clinical trials in the UK in 2001 alone. So there are some very substantial economic factors involved in this as well as benefits to patients.
	The regulations mainly reinforce current clinical trial practice in the UK. The major changes are that studies in healthy volunteers require an authorisation from the MHRA; investigational medicinal products must be manufactured to good manufacturing practice standards and the manufacturer must have a manufacturing licence; and each trial must have a sponsor who takes responsibility for it. The regulations allow a group to share those responsibilities. The regulations place our ethics committee system—I shall refer to ethics committees again later—on a statutory basis for the first time. It is easy to overlook that in view of some of the remarks made this evening.
	By clarifying the law we expect to create confidence in the public mind about the value of clinical trials and the safety of participating in them. This is essential if we are to see more and more patients in this country benefiting from clinical trials. The regulations provide a framework within which ethics committees can make independent decisions. They help to ensure that all UK trials of medicines provide reliable results and minimise risks by requiring that the principles of good clinical practice are followed. They protect participants from poor quality or badly prepared medicines by requiring the manufacture of investigational medicinal products to international standards of good manufacturing practice. They provide for inspections by the MHRA to ensure that the principles of good clinical practice and good manufacturing practice are being followed, which will improve the overall quality of UK clinical trials and help to identify misconduct. If misconduct persists or there is fraudulent conduct, the regulations provide powers of enforcement on a proper statutory basis.
	Turning to the protection of incapacitated adults, I thought that the noble Earl was unnecessarily pessimistic and I certainly side more with my noble friend Lord Turnberg on his interpretation of what the regulations do to protect incapacitated adults. In my view, they protect adults incapable of giving informed consent effectively; for example, those with severe Alzheimer's disease should be able to benefit from the research but in a protected way. The regulations do not permit experiments on incapacitated people without proper consent. I object to the comparison of the regulations to the activities of Hitler. I thought that was a little excitable. The noble Baroness alluded to the arrangements in the regulations being on a par with, and not far distant from, those activities. If she would like to clarify her position, I shall be glad to hear her.

Baroness Knight of Collingtree: My Lords, I am grateful to the Minister. I said—I stress this time and again—that I was worried about the principle. The principle is that mentally handicapped people can be used for experimentation without their consent. That was the line that I was following. That was exactly what was done in Nazi Germany. That is the point I was making.

Lord Warner: My Lords, if that is not linking the regulations to what was done in Nazi Germany, I do not know what is.
	The regulations restrict clinical trials on incapacitated adults to life-threatening or debilitating conditions from which the subject suffers. That is referred to in Schedule 1, Part 5, paragraph 11. I believe that that means that the kind of chest condition that the noble Earl, Lord Howe, mentioned would not be covered in these circumstances. The decision whether to consent to, or refuse, participation in a trial will be taken by a "legal representative" who is independent of the research team and can represent that person's presumed wishes. But they do not prevent incapacitated people participating in trials with the proviso that they can benefit or suffer no harm. I believe that my noble friend Lord Turnberg made the point very well about Catch-22 situations. I do not believe that we want to prevent incapacitated people securing the benefits from participating in clinical trials.
	These regulations provide a cascade system for seeking informed consent, first from a person whose relationship to the person makes them suitable to act as their legal representative; then from the doctor primarily responsible for the person's treatment and finally from a person nominated by the relevant healthcare provider. In the last situation a health service body can be expected to have a list of suitable nominated persons. In Scotland, except in cases of emergency treatment, the legal representative will be the person who is able to consent to treatment under the Adults with Incapacity (Scotland) Act 2000.
	The noble Earl, Lord Howe, raised the issue of why we proceeded in advance of the Mental Incapacity Bill. We had no option but to include arrangements for incapacitated adults because the directive specifically required the implementation by member states by 1 May 2004. I know that the wording of the directive is being considered very carefully with the draft Mental Incapacity Bill.
	To respond to other points, the directive makes clear that incapacitated adults can participate in trials. There must be grounds for expecting that administering the product will benefit the patient, as my noble friend Lord Carter suggested. There may be grounds for so expecting if there are good reasons for expecting that the treatment may benefit the class of patients to which he or she belongs. That enables patients to participate on that basis.
	A number of noble Lords raised the subject of the Helsinki Declaration 2000. There were wide-ranging discussions during the development of the directive on the reference to the declaration. The member states agreed that the directive should not be included in the articles of the direction, but only in the recitals. That was because the declaration would prevent placebo control trials, which would be disadvantageous to patients in our view.
	A number of noble Lords raised the subject of minors. The regulations also provide additional protection for a minor where that person is under 16 years of age. We expect more children to be asked to participate in clinical trials as part of an international initiative to provide medicines suitable for children that are fully licensed. We do need clear rules in this area.
	A number of noble Lords raised concerns about the implications of the regulations for the work of ethics committees. I say to some noble Lords that it is simply fantasy that UK Ministers are going to control appointments to research ethics committees. We do not have that system now. We have had to put UKECA in place because under the directive there has to be a UK body to oversee the establishment, recognition and monitoring of ethics committees. There is no statutory body at the moment in that area.

Lord Clement-Jones: My Lords, does not the directive specify an independent body? On what basis does UKECA qualify as such?

Lord Warner: Well, my Lords, UKECA is there to ensure that an activity is now being conducted, as in the past, through COREC to ensure that that work takes place. But COREC is not a statutory body; it operates under a contract between it and the Department of Health and the NHS research and development department. That is a long-established arrangement and involves a non-statutory body. Therefore, to provide proper accountability, we have established UKECA to ensure that there is a process to appoint a body to undertake that task. I would say that COREC is independent and that UKECA is not involved in the appointment of ethics committees.
	Perhaps I may continue with my line of argument. We had to have a body established under the regulations. As I said, COREC has existed for some time and does pretty well the same job that it has been doing for some time. As my noble friend Lord Turnberg said, there has been a need to consider how some ethics committees were working. There has been a need to group some of those activities in a particular way.
	Of course, sometimes when there is change in such areas, not everyone who is affected by the change sees things the way that COREC sees them. So concerns have been expressed in some quarters about how COREC has been operating. But it operates under contract; we monitor its work closely; and we take account of concerns that are expressed. The arrangements are in place for recognising phase 1 ethics committees. COREC is in urgent discussion with those committees to ensure that they can continue to operate under the regulations. We will be examining the workings of COREC as it undertakes the new work following from the regulations. But if there are concerns, we will of course listen carefully to them, as we have been doing so far.

Lord McColl of Dulwich: My Lords, I thank the Minister for giving way. Why cannot we have a statutory body that does not involve politicians? We have a number of such statutory bodies, such as the GMC. Why cannot we have something like that? Does the Minister not realise that people will be suspicious?

Lord Warner: My Lords, I recognise that people may be suspicious, but we need to have a UK-wide body, which is why we have brought together the health Ministers in UKECA. However, after the debate I will certainly consider what noble Lords have said. That issue has not caused concern so far and I do not believe that people think that UKECA will go round making appointments to local ethics committees. If there are concerns about perception, we will consider them, but we need a statutory body under the terms of the regulations that is UK-wide.
	Investigators and trial sponsors together must record and report serious unexpected adverse reactions to trial medicines under the regulations. MHRA assessors will look for signals indicating individuals who are at risk and consider whether the trial should be modified or stopped. Safety data from trials in each of the 25 member states will be entered into a European pharmacovigilance database that will track safety in clinical trials in its population of more than 400 million people. That provides a new, important safeguard for people in the UK. That is a powerful engine for picking up adverse reactions and concerns about drugs available in the European Union.
	I turn to some concerns that had been expressed here and by the statutory instruments merits committee about the good clinical practice directive. I thank the merits committee for drawing the House's attention to its concerns about that directive. In particular, it asks when it is likely to be available and what will be the likely effect of such a directive concerning the regulations.
	We delayed transposition of the directive into UK law for two main reasons; namely, the European Commission's delay in finalising two Commission directives and our need to consider the impact on academic research, to which a number of noble Lords have alluded.
	While the Commission has published a directive on good manufacturing practice, which is acceptable to the UK, it has not yet adopted its directive on good clinical practice. There is no indication when it will circulate a revised draft. The draft directive would have put not just the principles of good clinical practice into operation, but would also have put detailed guidance into binding legislation. That approach was unacceptable to us, and we said so—so did other countries, I am pleased to say. The delay has resulted therefore from the UK's and others' expressions of concerns.
	In the absence of an agreed Commission directive, I had to decide that the most sensible approach was, as in other countries, to include in the UK regulations the principles of GCP adopted by the International Conference on Harmonisation (ICH), which were agreed as the standard for Europe in July 1996.
	Currently, the pharmaceutical industry follows those ICH principles and academic researchers follow the Medical Research Council (MRC) guidelines based on the same principles. Effectively, we are changing nothing from the present arrangements in the UK.
	However, the Merits Committee recognised that there is a risk that the Commission will seek to issue a final GCP directive that does not include the principles of GCP as we have stated them. We shall just have to wait and see what happens, but we will continue to make our position clear on this issue to the Commission. I have nothing further to report on smoke signals coming out of Brussels on this issue.
	In February, I wrote to Members of this House and the other place to explain how I was taking the matter forward and my reasons for doing so. I have also had constructive meetings with Members of both Houses who have specific interests in clinical research, as well as with representatives from a large number of medical research charities, the Association of the British Pharmaceutical Industry and the BioIndustry Association. Each of those stakeholders has helped us in that area of activity.
	We also delayed introducing the regulations to be able to respond fully to the concerns of the academic research community. As part of that process, either I or my predecessor met senior representatives of the universities, the Royal Colleges, the medical charities, the MRC, the British Nursing Association and other groups with particular interests in clinical research. The MRC prepared a helpful report which identified the major areas of concern. I shall not go into detail, but that is when we set up the joint project between the Department of Health, the MRC and other interests in order to tackle some of those issues.
	I am also glad to say that along the way we have had discussions with Universities UK, which has just issued a joint statement with the Department of Health that is on the department's website. It recognises that the regulations do not change the underlying allocation of responsibilities in the partnership between universities and the NHS. That was an area about which there was some concern and misunderstanding.
	The MHRA has run a consultation and communications programme since the first draft of the directive in 1997. It has hosted conferences and workshops to disseminate information; distributed the formal consultation on the draft implementing regulations to more than 3,000 organisations; and it is using its website and that of the DH/MRC project to ensure that stakeholders learn of the different developments. We have put a great deal of effort in trying to explain these changes and to take people on board and understand what the new regulations are about. Given this range of consultation, it is inevitable that we have not made everyone content. I suspect that one or two of the people who have been less satisfied may have come to the attention of some noble Lords.
	In conclusion, I believe that we have made every effort to respond to the concerns of stakeholders. The approach that we have taken demonstrates the commitment of the Government to clinical research, which was demonstrated again today with the opening of the UK cell bank in Hertfordshire. We want a robust regulatory framework that will strengthen the UK's reputation for clinical trials. I am grateful for the help and support that we have had from a wide range of stakeholders. Perhaps I may be permitted to draw Members' attention to the supportive press notice put out by Cancer Research UK when the regulations were published.
	Ultimately, protection of individuals in clinical trials must be our priority. I recognise the concerns in this area that were expressed by a number of noble Lords, but I consider that the regulations strike the right balance between protecting public health and enabling high-quality trials in the UK. We shall look carefully at the points made by noble Lords and if there is any further reassurance I can give after reading Hansard, I shall do so, but the Government beg to oppose the Motion.

Baroness Knight of Collingtree: My Lords, perhaps I may intervene before the noble Lord sits down. To my certain knowledge, he has never been impolite in any way and I know that he would never wish to mislead the House. Can I not ask him again to reconsider his Answer to me on 5 May? He said:
	"Those conducting trials must obtain informed consent from all participants. Patients are provided with detailed information on the nature of the trial and have the right to withdraw at any time".—[Official Report, 5/5/04; col. 1097.]
	Is that not true only of some of the people who undergo those clinical trials? Is it not the case—we have seen it again and again throughout our discussion of the S.I.—that some people will undergo clinical trials who have not given permission? I am sure that the noble Lord would wish to make that clear.

Lord Warner: My Lords, I shall certainly go away and look at that Answer. As the noble Baroness says, it is never my intention—quite the reverse—to mislead Members of this House, or anybody else for that matter. My recollection of my Answer is that it interpreted the regulations in the form in which the legal representatives were operating them, whereby consent would be given where an incapacitated person is involved. However, I shall look carefully again at the Question of the noble Baroness and my Answer. If I have misled the noble Baroness, I shall certainly correct the matter.

Earl Howe: My Lords, I thank all noble Lords who have taken part in this debate, including the Minister for his reply. I recognise that the Minister has tried in his characteristic way to be helpful. Indeed, he has been illuminating in a number of important respects, but in other respects, I have to confess, his reply was disappointing. I do not intend to call a Division on my Prayer to annul, because there is a convention in the House that we do not do so and because the consequences of overturning a measure that implements an EU directive would be extremely problematic. However, if those constraints did not exist, I would seriously have considered asking the House for its opinion on the two or three serious issues that I attempted to raise. As it is, we may have to follow up some of those outstanding issues in writing.
	I noted what the Minister said about UKECA and the appointment of members of ethics committees. Regulation 7, read in conjunction with Schedule 2, makes it quite clear that UKECA is the body that appoints the members of NHS ethics committees. The Minister said that that will not happen in practice. If the intention is to make all appointments locally, why vest the power of appointment in Ministers? There is absolutely no need to do that. Indeed, one can have a statutory body to supervise research ethics committees, but as my noble friend Lord McColl said, it does not have to consist of Ministers. The HFEA is a good example of such a body to add to the one given by my noble friend. It is at arm's length from Ministers, but it is nevertheless statutory.
	Apart from that, I repeat that UKECA has the power not to recognise any committee of which it does not approve for any reason and to set up a committee in its place. In practical terms, that is a strong power. Why give Ministers those powers when the directive does not require it?
	Turning briefly to the issue of incapacitated adults, I listened carefully to what the noble Lords, Lord Carter and Lord Turnberg, had to say, and I am grateful to both of them. The problem, from my perspective, lies with the concept of the legal representatives. In her very powerful way, my noble friend Lady Knight voiced some worries about how these regulations might, in practice, be implemented, and I hope that the Minister will take those concerns on board.
	What troubles me is that the regulations embody a major change in the law. To my mind, the key point is that anyone taking a decision on behalf of an incapacitated adult to enter that adult into a clinical trial should be both independent and capable of weighing up the risks and benefits for the patient in an informed and dispassionate way. The whole concept of "legal representative", as set out in the regulations, seems to be fraught with difficulties. If you want to find the right sort of person to act as a legal representative—someone capable of ensuring that taking part in a trial is or is not in a patient's best interests—you need an independent third party. You should not look to a doctor or the staff of a hospital trust to act in that role. The responsibility should surely be in the hands of a lay person, possibly under the jurisdiction of the Court of Protection. Apart from anything else, I question whether doctors should be burdened with onerous decision-making of this kind. I say again that these are not matters that are appropriate to regulations.
	I was not happy with the answer the Minister gave on the Helsinki Declaration. Indeed, I could not completely follow it, and I may wish to pursue that point with him, if he will allow me to do so.
	Once again, I thank all noble Lords who have taken part in the debate. It is unsatisfactory to have to leave matters here, but for tonight, at least, we must do so. I hope and trust that the Minister will be receptive to further approaches outside the Chamber. In the mean time, I beg leave to withdraw the Motion.

Motion, by leave, withdrawn.
	House adjourned at eight minutes past nine o'clock.